Volunteer Application

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
Emergency Contact*

First NameLast Name
Phone Contact*

Area CodePhone Number
I work*

Full Time JobPart Time JobOther
I can realistically help _____ hours per week*
I can realistically volunteer on these days*
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 Roman's Travel with Care, LLC.
Do you have a valid drivers licence?*

YesNo
Provide your Driver's license id # and issued date, expiration date and state issued.
If you are volunteering to be a transporter provide the name of your auto insurance co. and policy #, phone #
I understand I am volunteering to be a transporter for Roman's Travel with Care, LLC I will be using my own personal vehicle, I further understand I can deduct the mileage and gas used for transporting from my personal tax returns. I further understand there may or may not be times I will be provided with travel expenses from Roman's Travel with Care, LLC. By volunteering my time and personal vehicle I agree to maintain a valid driver's license and a current auto policy. I understand I will not be covered under any insurance policy by Roman's Travel with Care, LLC for transporting. I further dismiss Roman's Travel with Care, LLC, it's agents, Board members, owners, paid employees, volunteers or principals of any liability for transporting.
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 Roman's Travel with Care, LLC 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
If I am accepted into the volunteer program I agree to adhere to all policy and procedures by Roman's Travel with Care, LLC *

Clear

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

Transporting

	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

Marketing - Newsletter, Publications

	1	2	3	4	5

1 is Not Interested, 5 is Very Interested

Volunteer Liability Release Form
Volunteers are an important part of Roman's Travel with Care, LLC and we welcome those who wish to participate in our programs. Steps to becoming a volunteer at Roman's Travel with Care, LLC:

1. You must attend a training class or previous experience.

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.*

Clear
If between 16-18 years old: I certify that my guardian* will be with me at all times while I am volunteering for Roman's Travel with Care, LLC

Clear
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:*

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 Roman's Travel with Care, LLC 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 Roman's Travel with Care, LLC 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 Roman's Travel with Care, LLC.
I agree to act in a professional manner while volunteering for Roman's Trvel with Care, LLC and I will not be under the influence of any alcohol, drugs, or substance that may alter my ability of volunteering and representing Roman's Travel with Care, LLC.
Signature*

Clear
Date

MonthDayYear
Guardian's Signature

Clear
Should be Empty: