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2. Date and Time*
   Date and Time

   Date and Time
4. First Name*
5. Last Name*
7. Address1*
9. Address2
11. City*
12. State*
13. Zip*
15. Contact Phone Number*
16. Email*
18. Are You 16 Years of Age or Older?*

    1. Yes
    2. No
19. Younger Than 16?*
    -- Select One --1514131211109876543 and Under

    Please select your age
21. Occupation*
22. May We Contact Your Work?*

    1. Yes
    2. No
    3. Unemployed/Retired
23. Work Phone Number
27. 1. In addition to your love of animals, why are you interested in volunteering for the CBBSB Animal Shelter?*
    Please explain.
29. 2. Some volunteer positions need to be filled on a regular basis.
    Please check the days and times you can commit too.
31. Days*

    1. Monday
    2. Tuesday
    3. Wednesday
    4. Thursday
    5. Friday
    6. Saturday
    7. Sunday
32. Times*

    1. Monday - AM 8:30 - 11:30
    2. Monday - PM 1:00 - 4:00
    3. Tuesday - AM 8:30 - 11:30
    4. Tuesday - PM 1:00 - 4:00
    5. Wednesday - AM 8:30 - 11:30
    6. Wednesday - PM 1:00 - 4:00
    7. Thursday - AM 8:30 - 11:30

    1. Thursday - PM 1:00 - 4:00
    2. Friday - AM 8:30 - 11:30
    3. Friday - PM 1:00 - 4:00
    4. Saturday - AM 8:30 - 11:30
    5. Saturday - PM 1:00 - 4:00
    6. Sunday - AM 8:30 - 11:30
    7. Sunday - PM 1:00 - 4:00

    Times can be adjusted based on availability but please select a time block(s) that work best for you.
34. 3. Please explain your experience as a volunteer:*
    Let us know if you have volunteered before and what you liked and loved about it!
36. 4. Please explain any special skills you may have that would be a benefit for CBBSB to utilize:*
    Worked with another shelter? Been a foster parent? In school for a Animal Science degree? Worked with special needs animals?
38. 5. If you are volunteering to fulfill a requirement for a program?*
    Please provide the following information: Name of Organization, Name of Contact Person, Phone Number
40. 6. Are You Allergic to Dogs?*

    1. Yes
    2. No
    3. Unsure
41. 7. Are You Allergic to Cats?*

    1. Yes
    2. No
    3. Unsure
42. 8. Do You Have Any Pets?*

    1. Yes
    2. No
44. If You Own Pets Please list:*
    Type, Age and Spayed/Neutered.
46. 9. Is There a Type of Animal You are Uncomfortable With?*
    We all have different experiences with animals and that is okay. Some people have encountered bad experiences with a specific breed of dog or size. Some people just don't prefer specific types of animals. We would like to know so that we do not push someone to be uncomfortable with our animals in turn making them uncomfortable.
48. 10. Will You be able to Respect Staff Decisions Regarding the Animals at the Shelter?*

    1. Yes
    2. No
    3. Unsure
52. Minors
    If you are a minor, a parent or guardian must be available to be reached by phone during the time at which the minor is volunteering at the shelter:
54. Parent or Gaurdian:
56. First Name*
57. Last Name*
59. Address1*
61. City*
62. State*
63. Zip*
65. Contact Phone Number*
66. Work Phone Number*
67. Relationship to Volunteer:*
69. Emergencies
    In case of there being an emergency it is important that we have an emergency contact as it is not always the same as a parent or guardian.
71. Emergency Contact
73. First Name*
74. Last Name*
76. Address1*
78. City*
79. State*
80. Zip*
82. Contact Phone Number*
83. Work Phone Number*
84. Relationship to Volunteer:*
86. PLEASE NOTE:
    CBBSB ANIMAL SHELTER RECOMMENDS THAT VOLUNTEERS COMING IN CONTACT WITH ANIMALS BE CURRENT WITH THEIR TETANUS VACCINATION.
90. VOLUNTEER AGREEMENT and LIABILITY RELEASE
    By initialing below, I hereby accept a position as a Volunteer for CBBSB Animal Shelter upon the following terms, conditions and understanding.
92. Terms and Conditions
94. 1. My services to the CBBSB Animal Shelter are provided strictly in a voluntary capacity without any express or implied promise of salary or compensation of any kind. This would include any employment type benefits, including employment insurance programs, worker’s compensation accrual in any form, vacation or sick time or any type of payment.*
    Initial
96. 2. I will familiarize myself and comply with CBBSB Animal Shelter policies and procedures applicable to community service workers. I will abide by the mission, rules, regulations, policies and programs of the CBBSB Animal Shelter while I am a community service participant. In particular, I fully understand that CBBSB expects high standards of moral and ethical treatment of animals under its care.*
    Initial
98. 3. I understand the CBBSB Animal Shelter, without notice or hearing, may terminate my services as a community service worker at any time, with or without reason. If termination occurs I will promptly return all CBBSB Animal Shelter supplies, equipment, records, and all other items in good, clean condition.*
    Initial
100. 4. I understand that as a community service worker I may gain access to information about CBBSB Animal Shelter, staff, customers, and other volunteers that is confidential. I agree to maintain confidentiality and refuse to disclose any information that is either private or personal.*
     Initial
102. Liability Release
104. 1. I understand that the handling of animals and other volunteer activities on my behalf of CBBSB Animal Shelter may place me in a situation that could result in injury to me or my personal property. I assume the risks of being bitten, scratched, injured or frightened by dogs, puppies, cats, kittens or other shelter surrendered animals in connection with my volunteer work.*
     Initial
106. 2. I authorize CBBSB Animal Shelter to seek emergency medical treatment for me/son/daughter/ward in case of accident, injury or illness and to indemnify and hold harmless CBBSB Animal Shelter in such an event. I understand that CBBSB Animal Shelter Workers Compensation policy volunteers are not classified “employees” and are therefore not eligible for coverage for injuries sustained while volunteering for CBBSB Animal Shelter.*
     Initial
108. 3. On behalf of myself, and my heirs, personal representatives and assigns, I hereby release the Chelsea Bailey Butte Silver Bow Animal Shelter of all liability for injuries, damages, liabilities, losses, judgments, costs or expenses whatsoever, which I might suffer or sustain in connection with the performance of my volunteer activities for CBBSB Animal Shelter.*
     Initial
110. 4. I discharge, indemnify and hold harmless CBBSB Animal Shelter, its directors, officers, employees, members and agents from any and all claims, lawsuits, injuries, damages, losses, costs or expenses whatsoever sustained by any shelter animal or any person in connection with my intentional misconduct or grossly negligent performance of volunteer activities for CBBSB Animal Shelter, or breach of CBBSB Animal Shelter’s rules, regulations, policies and programs.*
     Initial
112. 5. Understanding that public relations are an important part of volunteer’s activities on behalf of CBBSB Animal Shelter, I hereby authorize CBBSB Animal Shelter to use any photographs of me in its possession for public relations purposes. *
     Initital
114. 6. Any modification to this Agreement must be in writing signed by both parties. This agreement is binding upon CBBSB Animal Shelter, me and my respective heirs, successors, assigns, executors and personal representatives. *
     Initial
116. Sign and Date*
118. CBBSB Animal Shelter Respresentative
     *For shelter employee only*
Leave This Blank:


120. 1. Receive an email copy of this form.
121. Email address

     This field is not part of the form submission.

122. Submit

* indicates a required field