Volunteer Application

Today's Date *

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Full Name *

First Name Last Name

Home Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

E-mail *

Home Phone *

Area Code Phone Number

Mobile Phone *

Area Code Phone Number

Date of Birth

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I work *

Full Time Job Part Time Job Other

I can realistically help _____ hours per week *

I have health insurance *

Yes No

If you have health insurance, please note insurance company

If you do not have health insurance coverage, please understand that all expenses from possible injury wil be paid for by you personally and not by B.K.P.U.R

Have you ever been investigated by Animal Control? *

Yes No

Have you worked/volunteered with a humane society, shelter, or animal care? *

Yes No

If yes, please list organization(s)

Is your involvement with the organization(s) current?

Yes No

I also understand that behavior of domestic animals is at times unpredictable and that some domestic animals are capable of inflicting property damage, serious personal injury and even death. I am well aware of the risk of handling domestic animals, and with such understanding, I hereby waive, release and forever discharge B.K.P.U.R and its employees/volunteers, agents or trainers from any and all claims (whether present or future) arising out of the participation in the Volunteer Program.

Please rank the Volunteer Opportunities below

Being a B.K.P.U.R. model

	1	2	3	4	5
Worst						Best

Please upload a picture of yourself if you're interested in being a BKPUR model

Adoption Counselor / Greeter

	1	2	3	4	5
Not Interested						Very Interested

Socializing/Training Dogs or Cats

	1	2	3	4	5
Not Interested						Very Interested

Education - Developing Youth Programs

	1	2	3	4	5
Not Interested						Very Interested

Events - Planning, Setup, Advertising

	1	2	3	4	5
Not Interested						Very Interested

Fundraising - Special Events, Raising Funds

	1	2	3	4	5
Not Interested						Very Interested

Administrative - Phone calls, Emails, Screening Applications, Computer Work

	1	2	3	4	5
Not Interested						Very Interested

Social Media - Facebook, website, etc.

	1	2	3	4	5
Not Interested						Very Interested

Professional Cuddler in The Dog House

	1	2	3	4	5
Worst						Best

Carpenter / Landscaper

	1	2	3	4	5
Worst						Best

Marketing - Newsletter, Publications

	1	2	3	4	5
Not Interested						Very Interested

Volunteers are an important part of Brass Knuckle Pin Ups Rescue Inc. and we welcome those who wish to participate in our programs. Steps to becoming a volunteer with Brass Knuckle Pin Ups Rescue

1. You must have an application on file and have attended our training class.

2. Anyone that will be volunteering must willingly sign this form.

Today's Date *

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Full Name *

First Name Last Name

Date of Birth *

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I certify that as of today's date, I am over 18 years of age. *

Clear

I understand if I am between ages 16-18 yrs old a gaurdian must accompany me at all times while completing duties involving animals for B.K.P.U.R

Clear

Guardian's Name

First Name Last Name

Guardian's Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Guardian's Phone

Area Code Phone Number

Guardian's Address

Vaccination of Outside Pets: To protect outside pets from contracting any potential shelter diseases, and to prevent the shelter pets from developing illnesses from outside pets, I certify that all my personal pets or pets in a home that I frequent are, at a minimum, current on their rabies, distemper, bordetella, and parvo vaccinations.

Vaccination of Outside Pets: *

Clear

Zoonotic Disease/Rabies: I have been provided with written information regarding the potential exposure to common Zoonotic Diseases carried by Dogs and Cats including Rabies, Lyme Disease, Human Ehrlichiosis, Murine Typhus, Plague, and Intestinal Parasites.

Acknowledgement of Zoonotic Diseases *

Clear

Tetnis Advisory: You are strongly urged to have a current tetanus vaccination to protect yourself should you be cut, scratched or otherwise injured in such a way that tetanus infection could threaten your health.

Acknowledgement of Tetnis Advisory *

Clear

Release of Liability: I fully understand that as a part of my volunteer work at Brass Knuckle Pin Ups Rescue Inc. I will become in contact with animals either by direct handling or assisting in their care. Further, I understand that working with animals carries a risk of injury, and that it is possible that I may be bitten, scratched, and/or otherwise injured. I also understand that I may be exposed to canine and/or feline illness and disease and that it is also possible that I could indirectly expose my own pets to such illness and disease. My signature to this volunteer liability release attests to my intent to hold harmless and release from all liability Brass Knuckle Pin Ups Rescue Inc. and their agents and assigns from all acts which are related to my performance of any and all volunteer duties.

Photography Release: I agree to allow pictures of myself to be used, without compensation, for the purpose of the promotion and publicity related to Brass Knuckle Pin Ups Rescue Inc.

Signature *

Clear

Guardian's Signature

Clear

Date

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Volunteer Application

Volunteer Liability Release Form