Volunteer Application And Release

VOLUNTEER APPLICATION AND RELEASE

Flying Colors Bird Sanctuary of North Carolina, Inc. 105 North Spray Place Haw River, NC 27258 919-698-9584 www.flyingcolors-nc.com [email protected]

Name: _______________________________________________________________ Date:___________________ Home Phone: _____________________________________ Cell Phone:___________________________________ Address: _____________________________________________________________________________________ City/State: ______________________________________________________ Zip: _________________________ Email: __________________________________________________ Birth Date: ___________________________ Emergency Contact: ____________________________________________Relationship:______________________ Contact Phone (list all) __________________________________________________________________________ List a valid NC or VA driver’s license or valid ID and include expiration date: Please list any allergies to birds, cats, chemicals or physical, medical, psychological limitations or disabilities that might hinder you from safely participating in any area of the program? Are you currently pregnant or plan on becoming pregnant during your participation of this program? ____________ How often would you like to volunteer? (Please circle one) Once/week

Twice/week

Every other week

Special events

As needed

Days of the week you are available (Please circle one) Monday

Tuesday

Wednesday

Thursday

When are you available? (Please circle one)

Friday Morning

Saturday

Sunday

Afternoon

In a pinch

When will you be ready to begin volunteering? _______________________________________________________ If you are volunteering through your school, the court system or another agency, please provide name and phone number of contact person and number of service hours required: School or Employer: ____________________________________________________ Hours required: __________ Contact: ___________________________________________________ Phone: ____________________________ Education: (last year completed) ___________________________________________________________________ Special courses: ________________________________________________________________________________ Please list and formal education, training, and or experience in pet care or animal welfare? Course: ______________________________________________________________________________________

Certificates: ___________________________________________________________________________________ Have you been convicted or a felony of any kind or of a misdemeanor animal abuse within the past (7) years? Yes No If yes please explain, _________________________________________________________________ Have you had a tetanus shot or booster in the past (5) years? Yes No Since you may be handling animals, you may want to discuss current tetanus immunizations with your physician.

VOLUNTEER RELEASE I, ______________________________________________, hereby agree to accept a position as a volunteer worker for Flying Colors Bird Sanctuary of North Carolina, Inc. (FCBS Inc). In so doing, I agree to comply with all of the rules and regulations established by FCBS Inc., and I understand that failure to do so may result in my immediate termination as a volunteer. As a volunteer, I agree to do my best to represent FCBS Inc. to the public in an accurate and professional manner. I will support and advocate all of FCBS Inc policies. I acknowledge that as a volunteer I have not been given the authority to speak on behalf of FCBS Inc., and will not, unless I have been given that authority by an authorized representative of FCBS Inc. I acknowledge that my services are provided strictly on a volunteer basis, without any pay or compensation of any kind. I assume the risks of being bitten, scratched, injured or frightened by parrots in connection with my volunteer work for FCBS Inc. FCBS Inc. is not liable to me for any injuries, damages, liabilities, losses, judgments, costs, or expenses whatsoever that I might suffer or sustain in connection with the performance of my volunteer duties with FCBS Inc. I will indemnify and hold FCBS Inc. harmless from any claims, lawsuits, injuries, damages, losses, costs, or expense whatsoever sustained by any animal or person in connection with my misconduct or grossly negligent performance of volunteer activities for FCBS Inc. or any breach of FCBS Inc. rules, regulations, policies or programs. I understand that public relations are an important part of volunteering and I hereby allow FCBS Inc. to use any photograph taken of me for public relations purposes. I have accurately and truthfully completed this volunteer application.

________________________________________ NAME

_______________________________ DATE

FOR OFFICE USE ONLY Interview Date: ______________________ Orientation/Start Date: ___________________________ Entered Into Volunteer Database? Yes Date: ___________________ Comments: ________________________________________________________________________ _________________________________________________________________________________ _