Peace of Mind Dog Rescue · Volunteer Application

Personal Information

Name

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First Name

Last Name

Date of birth

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(mm/dd/yyyy)

Email

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Verify Email

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Email again

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Please enter the same email address again

Verify Email

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Address

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Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Home phone

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Cell phone

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What is your preferred means of communication?

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Home phone

Cell phone

Email

Text

In case of emergency, who can we notify for you? Relationship to you?

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Emergency contact phone

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Are you currently employed?

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Yes

No

Organization/Employer

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Occupation

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Are you currently in school?

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Yes

No

Name of school

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Grade/Level

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Do you have auto insurance?

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Yes

No

Insurance carrier

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Policy number

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How did you hear about us?

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Other

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Volunteering Information

Why are you interested in volunteering for POMDR?

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Please describe any previous volunteer or work experience with animals

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Please describe any other previous volunteer experience

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Do you currently have any pets?

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Yes

No

What types?

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Are they all spayed or neutered?

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Yes

No

Please explain (it is POMDR policy that all volunteers have their cats and dogs altered)

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Availability on weekdays

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Hours

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Availability on weekends

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Hours

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Types of Volunteer Work

You can find out more about the different types of volunteering on our volunteering page.

Please describe any other special interests, skills, training or hobbies that might benefit POMDR

Fostering Information

The answers to the following questions will help us make the best match when placing a foster dog in your care.

How long have you been at your current address?

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Type of housing

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House

Apartment

Condo

Other

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Do you own or rent your home?

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Own

Rent

Does your housing lease allow pets?

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Yes

No

Name of lessor

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Phone number of lessor

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How many adults at this address?

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Adults' ages

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How many children?

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Children's ages

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Have the children ever had a companion animal in the household before?

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Yes

No

Will your adopted dog be regularly interacting with children other than the children living in the home?

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Yes

No

Children's ages

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Is anyone in your household allergic to dogs?

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Yes

No

On an average weekday, how many hours would your foster dog be left alone?

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On an average weekend day?

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Do you have a securely fenced yard?

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Yes

No

Fence type and height

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Where will the dog live and sleep?

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The dog will be

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Strictly indoors

Strictly outdoors

Both indoors and outdoors

When and for how long would the dog be outdoors?

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Will the dog have full access to your home?

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Yes

No

Explain

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What exercise would a dog get in your care? (Number of walks, length, on leash, off leash, backyard play, etc.)

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Who will be the primary caretaker of the dog?

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Are there any smokers at your home?

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Yes

No

Do they smoke indoors?

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Yes

No

Do you expect that your current pets will accept a foster dog into your home with no issues?

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Yes

No

Explain

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Is there a certain type of dog that your current pets get along with best (taking into account gender, size, activity level, etc.)?

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Is there anything else you would like us to know about your ability to care for foster dogs, or any concerns you might have?

Agreements and Releases

Volunteer Confirmation and Agreement

I confirm that all information supplied on this application is true and correct, and acknowledge that my services will be performed at my own risk. I also acknowledge that POMDR retains the right to terminate my volunteer involvement at any future date, should it be deemed necessary.

I accept the Volunteer Confirmation and Agreement

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Yes

No

Volunteer Release

I hereby agree to accept a volunteer position for Peace of Mind Dog Rescue (herein after referred to as 'POMDR'), and in so doing, I agree to comply with all of the rules and regulations which may be established by POMDR, and I understand that failure to do so may result in my immediate termination as a volunteer. I further acknowledge that all services are performed at my own risk. On behalf of myself, my heirs, personal representatives and executors, I hereby release, discharge, indemnify and hold harmless POMDR, its board of directors, officers, staff and all other persons and organizations in any way connected with POMDR from any and all claims, causes of action, or demands, of any nature or cause, including costs and attorney's fees incurred by POMDR in connection with the same, based on damages or injuries which may be incurred or sustained by me in any way connected with my services for POMDR, including but not limited to animal bites, accidents, or injuries.

I accept the Volunteer Release

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Yes

No

Foster Agreement and Release

Provide food, water, shelter and appropriate amounts of human interaction for the foster dog.
Administer medications as prescribed.
All pre-approved medical care will be covered by POMDR including vaccinations and deworming.
The foster dog must wear his/her ID collar at all times.
POMDR must be notified immediately if the foster dog in your care is injured or missing.
If your foster dog becomes ill, you agree to contact POMDR immediately for approval before visiting a vet. You agree that every effort will be made to get pre-approval from POMDR for any medical attention the dog needs before any reimbursement will be made by POMDR.
Ownership of foster dogs remains with POMDR.
If for any reason your foster dog does not work out, you will notify POMDR immediately for return instructions.

I have read, understand, and agree to abide by the conditions of the POMDR Foster Home Agreement and Guidelines. I/We understand that all work done with POMDR is at my/our own risk, and hereby release POMDR and its employees, agents, members, and board of directors of any and all liability, property damages, personal damages and medical costs while I/we am/are providing volunteer foster care for POMDR.

I/We, hereby for myself (ourselves), heirs, administrators and assigns, fully, irrevocably and unconditionally release and agree to hold harmless POMDR and its employees, individual members, agents, board of directors from any and all known or unknown, anticipated or unanticipated, suspected or unsuspected and/or fixed, conditional or contingent, actions, causes of action, charges, suits, debts, demands, claims, contracts, covenants, liens, rights, liabilities, losses, royalties, costs, expenses (including, without limitation, attorneys' fees) or damages, including but not limited to any medical costs, damages to property, persons or other pets, of every kind, nature and description, at law or in equity, in connection with or arising from while I/we am/are caring for the agreed foster dog.

I accept the Foster Agreement and Release

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Yes

No

Photo Release

I understand that public relations is an important part of volunteering at POMDR. On behalf of myself, my heirs, personal representatives, and executors, I allow POMDR to use any photographs taken of me for use in public relations efforts. Also, all photographs that I submit to POMDR will remain the property of the photographer. POMDR will have the rights to use these photographs for marketing materials or in any other ways that POMDR sees fit.

I accept the Photo Release

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Yes

No

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