Volunteer Application

Today's Date*

MonthDayYear

Full Name*

First NameLast Name

Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

E-mail*

Home Phone*

Area CodePhone Number

Mobile Phone*

Area CodePhone Number

Date of Birth

MonthDayYear

I work*

Full Time JobPart Time JobOther

I can realistically help _____ hours per week*

I have health insurance*

YesNo

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?*

YesNo

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

YesNo

If yes, please list organization(s)

Is your involvement with the organization(s) current?

YesNo

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

1 is Worst, 5 is Best

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

Upload a File

Adoption Counselor / Greeter

	1	2	3	4	5

1 is Not Interested, 5 is Very Interested

Socializing/Training Dogs or Cats

	1	2	3	4	5

1 is Not Interested, 5 is Very Interested

Education - Developing Youth Programs

	1	2	3	4	5

1 is Not Interested, 5 is Very Interested

Events - Planning, Setup, Advertising

	1	2	3	4	5

1 is Not Interested, 5 is Very Interested

Fundraising - Special Events, Raising Funds

	1	2	3	4	5

1 is Not Interested, 5 is Very Interested

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

	1	2	3	4	5

1 is Not Interested, 5 is Very Interested

Social Media - Facebook, website, etc.

	1	2	3	4	5

1 is Not Interested, 5 is Very Interested

Professional Cuddler in The Dog House

	1	2	3	4	5

1 is Worst, 5 is Best

Carpenter / Landscaper

	1	2	3	4	5

1 is Worst, 5 is Best

Marketing - Newsletter, Publications

	1	2	3	4	5

1 is Not Interested, 5 is 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*

MonthDayYear

Full Name*

First NameLast Name

Date of Birth*

MonthDayYear

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

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

Guardian's Name

First NameLast Name

Guardian's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Guardian's Phone

Area CodePhone 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:*

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*

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*

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*

Guardian's Signature

Date

MonthDayYear

Volunteer Application

Volunteer Liability Release Form