Volunteer Update Form

 Please use the form below to update your information on file with us.  If you prefer you can download the form here.

Name:
Address:
City:
State:
Zip:
Phone:
Cell:
Email Address:

Is this a change from 2009?  Yes   No
If yes, please list previous information:

Name:
Address:
City:
State:
Zip:
Phone:
Cell:
Email Address:

Emergency Contacts:

Name: Phone:
Name: Phone:

 I am covered by medical insurance.
  Company: Policy#

 I am able to lift at least 10 lbs.
 Do you have any physical limitations?  Yes No
      If yes, please describe: 
 I am current on my tetanus vaccine    Year of vaccine: 

Please check the orientations you have attended:
Dog Walking  Cat Grooming  Community Events  Customer Service  Newspaper Laundry

Please note: We have expanded and combined some of the volunteer jobs for 2010. Please view our new volunteer job descriptions listed on our website. If you would like to attend one of the new orientations (no fee for active volunteers) or just get a "refresher course", please email me at terry.rozyla@geneseehumane.org. I'll contact you regarding orientation dates.

Hold Harmless Agreement

I agree to hold harmless the Humane Society of Genesee County in the event of any bodily (or other) injury to myself while at the shelter or on shelter related business while working as a volunteer. I acknowledge that I have been advised to secure any insurance needed to serve as a volunteer for the Humane Society of Genesee County.

I agree to the hold harmless agreement

Tetanus Waiver

I understand that because I may handle animals, a tetanus shot may be required for volunteers (if designated in job description). I am responsible for providing a copy of my tetanus shot record when my volunteer application is submitted. I release the Humane Society of Genesee County from all responsibility in the event of an animal bite or injury.

I have read, understand and agree to the above tetanus waiver

By submitting this form you are electronically signing this form.