NHS Volunteer Application

First Name*:

Last Name*:

Age*:

Date of Birth*:

Address*:

Address2:

City*:

State*:
FloridaAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareWashington DCFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennslyvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Zip*:

Home Phone:

Mobile Phone:

EMail*:

Company or School*:

Emergency Contact Name and Phone Number*:

We appreciate your desire to make a difference in the lives of animals waiting for their permanent homes. Please review the different volunteer opportunities and check all that interest you.

I would prefer to work with*:
DogsCatsBothNeither

I prefer to work on*:
WeekdaysWeekendsMorningsAfternoonsDoesn’t Matter

I would prefer to work:*
Housekeeping /ShelterFoster CareDog Park AssistantPet Training/TherapyDog Park Pool AttendantRemote AdoptionsSecond Chance Resale ShopFundraising / Special EventsCleaning the CatteryEvent CommitteesCat SocializationMarketing/PRDog WalkingLandscapingCleaning Dog KennelsGeneral MaintenanceMiscellaneous duties at shelterAnimal Enrichment (Filling Kongs ect.)

Please describe any special skills and interests that you would like to share with us*:

By signing below, I acknowledge that Nassau Humane Society (“NHS”) has warned me that working in an animal shelter with cats and dogs can expose me to animal bites/scratches and other injuries because all animals are unpredictable. I further acknowledge that I believe NHS has taken all reasonable precautions to protect me from injury and that I expressly assume any risk. Finally, I acknowledge that I am undertaking my volunteer work willingly and of my own accord, and that I hold NHS harmless for any injuries that I suffer as a volunteer

You must agree to the above terms to submit an application. A completed and signed waiver must accompany this application.

As a parent or legal guardian,I agree to the above terms for my young adult under 18 years of age and I submit his/her application.

Signature / Guardian Signature (Required under the age of 18.) *

Date*