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Name

Telephone

Address

Email Address

Department: Emergency Services- Animal Services Division

Potential Volunteer Activities (limit as age appropriate): Dog walking, cleaning, organizing paperwork, socializing/enriching dogs and cats, photography, washing dishes/laundry, filling Kongs, taking inventory of supplies, helping with events, assisting customers, speaking with adopters about animals, preparing animals for transports, small landscaping tasks.

Yes

Approximate length of volunteer service

Photographs / Video - I acknowledge and understand that photographs, films and recordings are sometimes made of volunteers for use in the creation of promotional materials, news releases, and for other documentary purposes. I hereby authorize the use of my/ my child’s image and voice to be used in any non-commercial manner by Catawba County and by any radio, television, newspaper, or other media.

Yes

Intent of the Parties / Severability - I acknowledge that if this Waiver and Release were to be deemed unenforceable in any way, I understand that it is the intent of the parties that it be enforced to the fullest extent legally permissible and that any provisions deemed unenforceable shall be severed and all remaining provisions enforced.

Yes

I have read the foregoing waiver and release and understand that it constitutes a formal legal document. By my signature, I acknowledge and consent to all of the foregoing.

Yes

Signature of Volunteer

Date

Signature of Parent/Guardian

Date

Signature of Animal Services Manager

Date

For our records please complete the following

Child/Volunteer information

Name

Address

Age

Emergency Information

In the event of an emergency, please contact

Name

Relationship

Address

Phone

Secondary Phone

Physician

Physician Phone

Known Allergies