1. I understand that volunteers must be at least 16 years old.
2. I understand that I may be handling animals while providing my volunteer services for Polk County Humane Society and therefore there exists a risk for personal injury. On behalf of myself, my heirs, personal representatives and executor, I release, discharge, indemnify and hold harmless Polk County Humane Society, its agents, servants and employees from any and all claims, causes of action or demands of any nature or cause connected with my volunteer contract. This could include any costs, attorney's fees and court costs incurred by Polk County Humane Society in connection with my volunteer services based on damages or injuries which I may incur in any way while volunteering. Such damages are not limited to but may include animal bites, accidents, injuries and personal property damage.
3. I agree to release, discharge and hold Polk County Humane Society harmless for any and all damage to my personal property while providing my services on a voluntary basis to Polk County Humane Society, its agents, servant and employees.
4. I understand that public relations are an important aspect of volunteer work at Pok County Humane Society. I, therefore, agree to allow Polk County Humane Society and its agents to use any photographs, video or film taken of me for use in public relations efforts. Polk County Humane Society will use all reasonable efforts to notify me but notification is not required for the photographs, video or film to be used for public relations purposes.
I (print name) _______________________________________ HAVE READ AND FULLY UNDERSTAND THE TERMS AND CONDITIONS OF THIS VOLUNTEER AGREEMENT AND I WILLINGLY COMPLY WITH ALL OF ITS CONDITIONS.
Parent or Legal Gaurdian of Volunteers Under 18 Years
As a parent or legal guardian of the above named Potential Volunteer, I hereby consent to my child/ward becoming a volunteer for the Polk County Humane Society and performing volunteer services as described in the Volunteer Agreement. I also Acknowledge that I have read the above Release and that I fully understand its terms and conditions. For myself and my child/ward, I agree to all of the terms and conditions of the Volunteer Agreement and Release
Volunteer Signature Date
Parent or Legal Guardian if Under 18 Years Old Date
PCHS Representative Signature Date
Polk County Humane Society
4404 S. 82nd Road
P.O. Box 334
Bolivar, Missouri 65613
Phone: (417) 777-3647
|Monday, Wednesday, Friday - Sunday||10:00 AM - 03:00 PM|