Harvest l{ills Animal Shelter, Inc. 1389 Bririgton Eoad - Fryeburg, Maine 04fi37 Yolunteer Application Date Name Address State City zip Telephone Day Evening Birthdate Why would you like to be a volunteer at Haryest Hills Animal Shelter? Is your volunteer service court ordered? NO Yes When are you available to volunteer? ) I Friday (time [ ] Monday ) I Saturday (time [ ] Tuesday I Sunday (time. [ ] Wednesday (time------------) ) [] Thursday What type of activities would you like ta share? _ Socializing catslkittens Sociaiizing dogs/puppies _ Fund Raising Outdoor work details _Indoor work _ Shopping Grooming _ Thrift _Maintenance _ At-home projects _ Education (schools) Coin Canisters (time (time (time details Shop MEDICAL - - Have you had a tetanus shot within the last 10 years? (recommended) [ ] no [ ] yes date-==.-- - Have you ever had rabies shots? [ ] no[]yes-date. Do you have any allergies? [ ] no [.I yes - specify Do you have medical insurance? [ ] no[]yes In case of emergency, please notifli: Phone understand that"handling animals does involve some risk and thatHarvest Hills Animal Shelter, Inc. is not liable for any injury I sustain while I am a volunteer at the Shelter. In the event of an emergency,I hereby give my permission for the person in charge at Harvest Hills at the time of the emergency to see that I arn brought to the emergency room at the Bridgton Hospital in Bridgton. At that time, medical personnel will secure proper treatment for me. I have read and understand the Halest Hills Animal Shelter,Inc. documents entitled "Volunteer and Safety Policies" and agree to abide by these policies. I Signature Date HHAS Approved by Date