Volunteer Form – Moline Animal Aid

Choose those you are interested in.

Answer Phone and Messages
Animal Adoptions
Secretarial and Data Input
Photographer
News Letter
Fundraisers
Transporting Animals to Vet
Working with the Cats
Working with the Dogs
Assist Medical Team
Foster Care
Building Maintenance
Cleaning Shelter
Cleaning Cages Petco

List any talents or skills you have that you feel ,may benefit the shelter.

Events to Volunteer

Bald Eagle Days
Annual Yard Sales
Trivia Events
New Upcoming Events

How many hours per week would you be able to dedicate?

What days of the week are you available?

What time do you wish to start?

Mornings between 7 and 9 am
Mornings between 9 and 11 am
Afternoon between 11am and 2 pm

How did you find out about our organization?

Other

Name *

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Phone *

Cell Phone

Date of Birth if under 18

If Under the Age Of 18 you must have parental consent to volunteer.

Have you had tetanus shot within the past 3 years?

Yes
No
Don't Know

A booster shot is recommended every 10 years

Do you have Allergies

Yes
No
Not Sure

Do you have medical insurance coverage?

Yes
No
Not Sure

RELEASE MUST BE FILLED OUT

If the volunteer listed on this form is under 18 years, the parent / legal guardian must also sign.

I agree to conform to the Animal Aid Humane Society policies and procedures.

Yes
No

I agree to respect the confidential nature of information I may obtain.

Yes
No

I agree to participate in training as is required by my assignments

Yes
No

I understand that my failure to follow Animal Aid Humane Society's policies and procedures may result in the termination of my service as a volunteer from Animal Aid Humane Society.

Yes
No

As a volunteer or the parent/legal guardian of a minor working in the capacity of a volunteer at the ANIMAL AID HUMANE SOCIETY, I do hereby release from any liability or responsibility concerning an injury, illness, or death caused by any animal, or event that is connected to the ANIMAL AID HUMANE SOCIETY in any way, whether it would be on ANIMAL AID HUMANE SOCIETY’S property or elsewhere.

Yes
No

Signature *

Signature Parent / Legal Guardian