Volunteer Application Step 1 of 2 50% Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country A phone interview and a review of references is required before an orientation is scheduled. This is a standard Yavapai Humane Society procedure to insure that our organization is the right fit for you!* You may call me for an interview Phone*Email* Emergency Contact InformationEmergency Contact Name* First Last Emergency Contact Phone*Volunteer InformationI am volunteering* because I enjoy helping homeless pets to fulfill court-ordered community service for a school project other please check all which applyIf other please describeI am 18 or older* Yes No Date of Birth* Date Format: MM slash DD slash YYYY Select ALL categories of interest to you* Animal Care Adoption Counselor Fundraising/Special Events Offsite Events Shelter Care PetSmart Cat Adoption Center Equine Center Administrative/Data Entry Education Presentations/Shelter Guide YHS Thrift Store Spay/Neuter Clinic Skills* Handyman Fundraising Typing/Data Entry Marketing Computer Savvy Administration Public Speaking Customer Service Other skills:Please list two references complete with name, phone number and relationship:*Yavapai Humane Society relies on donations for over 90% of our funding you will be asked to submit $15 per person at volunteer orientation. This helps cover the cost of the name tag, shirt, and other program expenses.* I understand and agree to pay the $15 orientation fee. Statement of Agreement*Please read each statement, check the box and indicate agreement by your signature below. I agree not to consume, use, possess or be under the influence of any drug or alcohol products while volunteering for Yavapai Humane Society. I understand that any conduct or pattern of conduct that would tend to disrupt, diminish or otherwise jeopardize public trust in Yavapai Humane Society will result in dismissal. I understand that my volunteer assignment with Yavapai Humane Society may be terminated at any time. I have NOT been convicted and/or placed on probation for any criminal offense. RecordIf you have been convicted of a crime and/or placed on probation, please list date and nature of the offense: I understand that depending upon the nature of the volunteer assignment, Yavapai Humane Society may deem it necessary to obtain a Driver’s License Record, Sex Offender Record, and/or a Criminal Conviction History and Wanted Information Reports on individuals volunteering for Yavapai Humane Society. YAVAPAI HUMANE SOCIETY (YHS) AGREEMENT OF WAIVER OF LIABILITY & HOLD HARMLESS AGREEMENT*I hereby agree to accept a position as a volunteer worker with YHS, and in doing so, I agree to comply with all the rules and regulations established by, 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 the Yavapai Humane Society in an accurate and professional manner. Volunteers may be entrusted with sensitive and confidential information while volunteering. Information relating to YHS employees, volunteers, customers, and donors is confidential. I agree that I will not disclose or make any use of such confidential information. I agree to accept such appointment subject to receiving the training provided by YHS and understand that my participation is purely voluntary, without compensation. Participation may be withdrawn or denied for any reason without cause. I understand that public relations are an important part of volunteering at Yavapai Humane Society. On behalf of myself, my heirs, personal representatives, and executors, I hereby allow the Yavapai Humane Society to use any photographs taken of me for use in public relation efforts. By signing this agreement I agree not to sue, and to release, waive, discharge and hold harmless the Yavapai Humane Society and all their directors, agents, and employees from any, and all liability, claims, demands, actions, and causes of action whatsoever arising out of or related to any loss, damage, or injury, including death, that may be sustained by me, or to any property belonging to me while participating in any volunteer activity on behalf of the Yavapai Humane Society, or in transportation to and from any volunteer activity of the Yavapai Humane Society.EmailThis field is for validation purposes and should be left unchanged.