Volunteer Home » Support Us » Give Your Time » Volunteer » Volunteer Application Form Volunteer Application Form Thank you for considering becoming a volunteer with the Peterborough Humane Society. Volunteer Application Step 1 of 3 33% Contact InformationName* First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Home PhoneCell PhoneWork PhoneEmail* Preferred Method of Contact Phone Email Access to a vehicle? Yes No Acces to a vehicle? Yes No Emergency Contact InformationName First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Home PhoneCell PhoneWork PhoneAvailabilityDuring which hours are you available for volunteer assignments? Mornings Afternoons Evenings Weekends Areas of InterestsInterests Board of Directors Shelter Maintenance Greeter Dog Walker Pet Transport Administrative Support: Database management, research projects Dishes Awareness / Community Champion: Promotions, presentations Bingo Cat Socializing Special Events Kids Camp Tell us in which areas you are interested in volunteering. Please note that not all opportunities are available at any given time.ReferencesPlease provide two references. At least one reference should be related to paid employment or volunteer work. 1st ReferenceName* Phone*Relationship* 2nd ReferenceName PhoneRelationship Police CheckPlease note that we now require a copy of an up to date Police Record Check for all volunteers. Do you have an up to date Police Check?* Yes No If you do not have one, we will gladly help you make that happen. I Agree to the Following: That I shall not appear for volunteer service under the influence of alcohol or illegal drugs. That if I drive a vehicle to the volunteer site or during the course of my volunteer work, my personal vehicle insurance provides adequate insurance coverage. That any photographs, videotapes, motion pictures or recordings taken of me may be used for publicity purposes for the Peterborough Humane Society. The Peterborough Humane Society may send me email announcements of additional fundraising event volunteer opportunities and sign me up to receive the E-Newsletter. I can choose to opt out of receiving such emails by checking the Opt Out box below Opt Out of newsletter and promotional emails Opt Out of Mailing List Confidentiality AgreementI pledge to uphold professional and ethical standards in respect to all information with which I come in contact with during my volunteer engagement with the Peterborough Humane Society. I pledge that all information will be held in strictest confidence to ensure the anonymity and safety of all who are affiliated with the Peterborough Humane Society. This applies to matters relating to: • Animals and/or donors associated with the Peterborough Humane Society • All business of the Society presently in force, or future projected affairs and activities under consideration by the Peterborough Humane Society. Volunteer Release & Waiver of LiabilityI waive and release any and all claims for myself, my heirs, my next of kin, executors, administrators and assigned representatives against the Peterborough Humane Society and any other sponsor or organization involved, from any and all liability for any loss, damage, expense, or injury including death or incapacity, however caused, including any claim or liability arising from the negligence of the Peterborough Humane Society and its agents (employees, students, volunteers) arising out of, or in the course of, my participation as a volunteer for which I choose to participate. This Release and Waiver extends to any and all claims, foreseen and unforeseen, known or unknown. I agree to HOLD HARMLESS AND INDEMNIFY the Peterborough Humane Society from any and all liability for any property damage or personal injury to any third party resulting from my participation in volunteer activities with the Peterborough Humane Society. I understand that as a volunteer with the Peterborough Humane Society I am NOT covered by the Ontario Workplace Safety and Insurance Act and that, as a result, I am not entitled to make any claims for compensation pursuant to the Ontario Workplace Safety and Insurance Act. I agree not to make any statements, written or verbal, that defame, disparage or in any way criticize the personal or business reputation, practices, or conduct of the Peterborough Humane Society and its agents. I confirm that I have read and understood this agreement prior to signing it, and I am aware that by signing this application I am waiving certain legal rights which I or my heirs, next of kin, executors, administrators, assigns and representatives may have against the Peterborough Humane Society. Consent* I agree that the information provided on this form may be used to determine my suitability for this position, including the contacting of references indicated above.*