Volunteer Application Volunteer Application Please fill out the following information if you are interested in volunteering with Safe Home Rescue. Name* First Last Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code County of Residence*Phone*Email* What kinds of volunteer activities are you interested in?* Being a Temporary Care Home Helping at Adoption Events Administrative duties Grant Writing or Fundraising Transport Home InformationDo you own your home?* Yes No Do you carry current Home Owner's or Renter's Insurance?* Yes No What company caries your Home Owner's or Renter's Insurance?*If renting, landowner'sLandowner Name* First Last Landowner's Phone*Do you plan to move in the near future?* Yes No Number of Adults in your Household:*Number of Children in your Household*Do you Currently Have Pets?* Yes No Do you agree to provide supervision of the interaction between children and the temporary care pets and/or between your pets and the temporary pets?* Yes No N/A How many pets do you have?Dogs:Cats:Other, list type and how many:Are they spayed/neutered?* Yes No Why aren't your current pets spayed/neutered?*Are they up to date on all vaccinations?* Yes No Why aren't your current pets up to date on vaccinations?Your Vet's Name:*Your Vet's Phone Number:List any pets that you have had within the last three years and no longer have: (Type & Reason)What kind of pets are you interested in providing temporary care for? (check all that apply)* Cats Kittens Dogs Puppies Rabbits/Small Animals Have you owned or provided care for this type of pet?* Yes No Do you give consent for a Safe Home Rescue volunteer to visit your home prior to approving this application or to check on a temporary pet in your care?* Yes No Do you give consent for potential adopters to visit your home to meet a temporary care pet you have that is up for adoption?* Yes No How many hours per day will the pet(s) be left alone?*How many days per week will the pet(s) be left alone?*Who will be responsible for the pet’s care?*Do you understand that allowing your personal animals to interact with the temporary care pets can pose health risks to your animals?* Yes No Dogs/PuppiesPlease complete this section only if you are interested in providing care to dogs and/or puppies.Do you have a fenced yard?* Yes No If not, how will you provide safe and adequate availability to the outside for exercise and housetraining?*Where will the dog/puppies spend most time when you are home and available to supervise?*Where will the dog/puppies be when you are not home or unable to supervise?*Are you willing to work with the dog/puppies by using positive reinforcement to correct problem behaviors should they occur?* Yes No Do you understand that many of the dog/puppies may not be fully housetrained or may have accidents due to the change in their living conditions?* Yes No Are you willing to work on housetraining?* Yes No Cats/KittensPlease complete this section only if you are interested in providing care to cats and/or kittens.Where will the cat/kittens be spending most of the time when you are home and available to supervise?*Where will the cat/kittens be when you are not home or unable to supervise?*Are you willing to work with the cat/kitten to correct problem behaviors should they occur? (e.g. not using the litter box, scratching, digging in plants, etc)?* Yes No What will you do if the cat/kittens do not stay off of table/countertops?*What will you do if the cat/kittens do not use the litter box?*Are you willing to place any toxic plants out of reach or remove them from the home (common household plants are philodendron, aloe, poinsettia, and ivy)?* Yes No Will the cat/kittens be allowed outside?* Yes No If yes, how will you make sure I am safe from other animals, weather, and traffic?*Additional Information/CommentsList any additional information/comments: Temporary Care Home Agrees: All information provided is accurate to the best of his/her knowledge. He/she is 18 years or older. To provide shelter, fresh water, proper food and adequate companionship to the pets in their care. To keep pets primarily indoors and that proper restraint must be used when outside. To administer medication, heartworm preventative (dogs) and flea prevention as required and provided by Safe Home Rescue. To follow positive training methods. To contact Safe Home Rescue for guidance prior to providing any medication or vet care. Safe Home Rescue cannot reimburse for veterinary fees provided without prior permission. To allow a Safe Home Rescue representative to periodically check on this pet to be assured of compliance with the terms of this contract. To follow the adoption policies of Safe Home Rescue regarding the approval of adoptions. RELEASE OF LIABILITY AND INDEMNIFICATION Adopter agrees to be responsible for the care of this animal and to indemnify and hold harmless Safe Home Rescue from claims of liability for the conduct of the pet while in temporary care. Safe Home Rescue will pay for all supplies and vet care when approved by the Rescue. Volunteer Agrees: All information provided is accurate to the best of his/her knowledge. He/she is 18 years or older. To represent Safe Home Rescue in a positive manner. To follow positive training methods. To follow all Safe Home Rescue policies and guidelines. Checking this box below indicates your acceptance to the terms stated above.* I Agree This iframe contains the logic required to handle Ajax powered Gravity Forms.