Application Date        Date of Birth  (Must be 18 years of age to volunteer)      Your Gender  Male Female  

Name    

Address    City       State     Zip         

 Home Phone       Work Phone    Cell Phone 

Fax       Email 

Best Method to contact you  Select Phone Email Fax U S Mail    Best time to contact 

In the event of an emergency who should we notify?
Name     Phone 

Which volunteer areas would you be interested in helping with?  Check as many as you like

  Animal Socialization                       Foster Care (Please fill out a Foster Application Form)

  Fundraising                                     Education

  Grooming/ Bathing                          Events

  Transport                                          Other (Specify)

Specify 

Do you have any prior experience in the areas you have indicated above? 
Please explain

Do you have other abilities or skills that you think might be beneficial to Countryside Animal Rescue?

Be Specific about what you would like to do with your volunteer time at Countryside Animal Rescue

Do you have any physical or other limitations relating to
the type of volunteer work you would be able to perform? 
Anything CAR should be aware of?

Are you a member of Countryside Animal Rescue?     Yes     No

Have you ever been convicted of a Felony?     Yes     No

Volunteer Release

·        I agree that I will adhere and abide with the rules and regulations,
policies and programs of Countryside Animal Rescue, Inc. (CAR).

·        I fully understand that CAR has the right to refuse a volunteer application for any reason. 
CAR may also request that a volunteer leave our volunteer program at any time for any reason. 
I understand that I am free to leave the CAR volunteer program at any time for any reason without prior notice.

·        I hereby fully and forever release and discharge Countryside Animal Rescue, Inc.,
its agents, employees, directors, officers, and liability insurance carriers, for all actions,
damages, or judgments which I have now or in the future against
Countryside Animal Rescue, Inc., for all personal injuries to myself known or unknown,
and/or arising out of activities as an adult volunteer for Countryside Animal Rescue, Inc.

     I Agree     I Disagree

Please Enter your full name   (This will serve as a Release Signature)