*Orientation Date:
(See Volunteer page for available orientation dates.)

*First Name:

*Last Name:

*Address:

*City:     *Zip:

*Home Phone:
 Cell Phone: 

Employer:    Occupation:

Work Phone:
May we call you at work? Yes No

*Email Address:

*Birthday:(month/day)

Education completed: Choose One In High School In College College Graduate Other
if other

If you are a junior volunteer (under 17) what is your full birth date?     Age:
All junior volunteers must be accompanied while volunteering by the parent or adult guardian, who also attended the orientation, while volunteering at Pet Orphans.

What languages, other than English, do you speak?

Pet Orphans is a private pet adoption agency. A small staff has primary responsibility for the day-to-day operation of the shelter, but volunteers handle much of the adoption process and also have an important role in caring for and enriching the lives of the animals who stay with us. For these reasons, we would like to know about your past experience in volunteer work and with animals.

How did you hear about our volunteer program?


Please tell us briefly why you would like to become a Pet Orphans of Southern California volunteer.


Do you have any prior experience as a volunteer? If yes, for which organization(s) did you volunteer? What were your duties?


Have you ever had experience in an animal care related field?


Volunteering at Pet Orphans of Southern California is not only animal-related; it also involves contact with the general public. How do you feel about interacting with all types of people?


What are your special skills, interests, and hobbies?


Do you have any questions or comments about Pet Orphans of Southern California?


Past or Present Pet Ownership: For each animal you have owned, please describe the type of animal (dog/cat/other), breed, how you acquired it (pet store, shelter, etc.), and whether you still have it or what happened to it.


When will you be ready to begin volunteering?


Are there any restrictions, such as a school/work schedule, that may affect your availability?


Have you ever been convicted of a felony? Yes   No

Volunteer Job Descriptions: Please let us know what volunteer opportunities interest you by listing them in the box in the order you are interested (i.e. first choice comes first, second choice second, etc.). The list of volunteer jobs is at the top of this page. Each position has different availability levels depending on our need at the time of your application. If you have special skills to offer, please list those as well.

APPLICANT’S AGREEMENT
By initialing this application (since submitting on-line, originals to be signed at Volunteer Orientation), I understand and agree to the following:

1. I authorize Pet Orphans of Southern California ("POSC") to seek emergency medical treatment for me in case of accident, injury or illness.

2. I agree to abide by the policies and procedures presented to me in the volunteer handbook, at the volunteer orientation and subsequent training sessions and acknowledge receipt of said handbook.

3. I agree to accept supervision and instructions from the staff relating to my duties at POSC.

4. I will take ideas, constructive comments, concerns and suggestions directly to the Volunteer Manager.

5. If communication problems develop between employees or other volunteers and me, I will report these to the Volunteer Manager as soon as possible.

6. I understand that if I am injured while acting as an unpaid member of the volunteer staff, I am not covered by California State Worker’s Compensation Law.

7. I understand the risks present in volunteer duties, particularly in working with animals, and walking said animals in an industrial area, and freely assume those risks and agree to release and indemnify POSC, it’s officers, agents, employees and volunteers from and against all claims for injury, accident, loss or danger to the undersigned as a result of such volunteer duties.

8. I agree that POSC may use any photos of me or my name in any POSC produced materials and waive any and all remuneration for use of name and/or photo.

9. In addition to the above points for which I agree on behalf of me and, if applicable, my Minor child, I hereby authorize POSC, and the emergency contact listed below, to seek emergency medical treatment for (list minor child volunteer, if applicable) and/or me in case of accident, injury or illness. It is understood that an effort will be made to contact me (in the case of my minor child), or the person listed below as an emergency contact before taking this action.

Name:

Initial Here to Agree:     Date:

Emergency Contact Information:
In case of an emergency, whom should we notify?

Name:

Relationship:

Address:

Home Phone:

Work Phone:

Cell Phone:  

Please be advised that Pet Orphans has the right of refusal of your application for any reason, and can terminate your volunteer duties at any time.

PET ORPHANS Of Southern California – INDEMNITY WAIVER AND RELEASE OF LIABILITY - ASSUMPTION OF RISK
(Original to be signed at Orientation upon receipt of Volunteer Handbook)

, wish to participate as a volunteer at Pet Orphans of Southern California ("POSC").

In consideration for being permitted by POSC to participate as a volunteer, I hereby agree that I will assume full responsibility for the death, personal injury and/or property damage suffered or sustained by or to me as a result of or in connection with my participation as a volunteer.

I agree, therefore, to release and indemnify POSC (and for purposes of this agreement "POSC" shall also include its Officers, Employees, Agents and Volunteers collectively) from and against all liability, claims, demands, damages to my person or property suffered or sustained as a direct or indirect result of my participation as a volunteer; even if such death, personal injury or property damage arises out of the negligence of POSC.

I further agree, that I will not make any claim against, sue, attach the property of, or prosecute POSC for any death, personal injury or property damage, whatever the cause or place of the event giving rise to the claim, in which I may suffer or sustain as a result of or in connection with my participation as a volunteer.

In addition, I hereby release and discharge POSC from all actions, claims or demands that I now have or may hereafter have for any death, personal injury and/or property damage arising out of or in connection with my participation as a volunteer.

I further understand that the behavior of domestic animals is unpredictable and that domestic animals are capable of spreading disease and/or inflicting serious personal injury or death, as well as extensive property damage. Knowing the risks of handling domestic animals; nevertheless, I hereby agree to assume those risks and to release, indemnify and hold harmless POSC and the persons mentioned above who might otherwise be liable to me (or my heirs or assigns) for damages.

It is understood and agreed that this Indemnity Waiver, Release of Liability and Assumption of Risk is intended to be binding on my heirs, distributees, guardians, legal representatives or assigns.his Indemnity Waiver, Release of Liability and Assumption of Risk is intended to be binding on my heirs, distributees, guardians, legal representatives or assigns.

I HAVE READ THIS AGREEMENT CAREFULLY AND FULLY, AS WELL AS THE VOLUNTEER HANDBOOK, FOR WHICH I HEREBY ACKNOWLEDGE RECEIPT OF, AND FULLY UNDERSTAND THE CONTENTS. I AM AWARE THAT THIS IS AN INDEMNITY, WAIVER AND RELEASE OF LIABILITY AND A BINDING CONTRACT BETWEEN POSC AND MYSELF, AND I SIGN IT OF MY OWN FREE WILL.

Dated:
Volunteer Name:

PET ORPHANS FUND – INDEMNITY WAIVER AND RELEASE OF LIABILITY - ASSUMPTION OF RISK
JUNIOR VOLUNTEER – (Release by Parent or Guardian of a Minor – under 18)
(Original to be signed at orientation upon receipt of Volunteer Handbook)

I, , am the parent or legal guardian of (the “Minor”), who wishes to participate as a volunteer at Pet Orphans of Southern California (“POSC”).

In consideration for the Minor being permitted by POSC to participate as a volunteer, I hereby agree that I will assume full responsibility for the death, personal injury and/or property damage suffered or sustained by the Minor as a result of or in connection with the Minor’s participation as a volunteer.

I agree, therefore, to release and indemnify POSC (and for purposes of this agreement "POSC" shall also include its Officers, Employees, Agents and Volunteers collectively) from and against all liability, claims, demands, damages to the minor’s person or property suffered or sustained by the minor as a direct or indirect result of the Minor’s participation as a volunteer; even if such death, personal injury or property damage arises out of the negligence of POSC.

I further agree, for myself and for the Minor, that neither I nor the Minor will make any claim against, sue, attach the property of, or prosecute POSC for any death, personal injury or property damage, whatever the cause or place of the event giving rise to the claim, in which the Minor may suffer or sustain as a result of or in connection with the Minor’s participation as a volunteer.

In addition, for myself and for the Minor, I hereby release and discharge POSC from all actions, claims or demands that Minor or I now have or may hereafter have for any death, personal injury and/or property damage arising out of or in connection with the Minor’s participation as a volunteer.

I further understand that the behavior of domestic animals is unpredictable and that domestic animals are capable of spreading disease and/or inflicting serious personal injury or death, as well as extensive property damage. Knowing the risks of handling domestic animals; nevertheless, on behalf of the Minor and myself I hereby agree to assume those risks and to release, indemnify and hold harmless POSC and the persons mentioned above who might otherwise be liable to the Minor or to me (or the Minor’s or my heirs or assigns) for damages.

Furthermore, I understand that if my minor child is permitted by POSC to volunteer without my being present, I have been informed that my child will NOT be provided with any adult supervisor while on the property or walking dogs in the neighboring industrial area, for which I have been hereby informed of the risks and I assume all risks of the Minor working independently.

It is understood and agreed that this Indemnity Waiver, Release of Liability and Assumption of Risk is intended to be binding on the Minor’s and my heirs, distributees, guardians, legal representatives or assigns.

I HAVE READ THIS AGREEMENT CAREFULLY AND FULLY, AND AGREE TO IMMEDIATELY AND THOROUGHLY READ THE VOLUNTEER HANDBOOK AND INSURE MY MINOR CHILD UNDERSTANDS THE POLICIES AND PROCEDURES, FOR WHICH I HEREBY ACKNOWLEDGE RECEIPT OF. I AM AWARE THAT THIS IS AN INDEMNITY, WAIVER AND RELEASE OF LIABILITY AND ASSUMPTION OF RISK AND A BINDING CONTRACT BETWEEN POSC AND MYSELF AND MY MINOR, AND I SIGN IT OF MY OWN FREE WILL.

Dated:
Volunteer Name:

CONFIDENTIALITY AGREEMENT
Pet Orphans of Southern California

In the pursuit of its objectives, Pet Orphans of Southern California ("POSC") finds it useful and necessary to use the services of volunteers, contract employees and others outside the regular employed staff. At times these individuals will be permitted to see and use books, records, computer data and programs and other information deemed by POSC to be its property and, therefore, proprietary. This information includes, without limitation, donor information, staff meeting discussions, volunteer identification information, address and phone lists, planning documentation, computer programs, operational financial background information and current financial material.

In executing this document I recognize the proprietary nature of this property. I promise that I shall not convert or use this proprietary property in any manner for any purpose not authorized by POSC.

Executed on in Van Nuys, California

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