Fillable Dane County Humane Society Volunteer Application

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Dane County Humane Society Volunteer Application

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FIRST
CONTACT:
POSITION:
ORIENTATION
DATE:
ENTERED IN
VOLGISTICS
FOR ADMINISTRATIVE USE ONLY
Dane County Humane Society Volunteer Application
Dane County Humane Society is currently recruiting adults and children age 8 and older to participate in our
volunteer program and support our mission Helping People Help Animals.
VOLUNTEER INFORMATION – Fill out a separate application for each family member interested in volunteering
Legal Name:
Last First Middle (full)
Birth Date: Driver’s License #:
The minimum age to volunteer is 8 and volunteers between the ages of 8 and 12 must be trained with and volunteer with a parent/guardian. A
separate volunteer application must be filled out for the parent/guardian and each youth interested in volunteering together.
E-mail address:
E-mail is our preferred method of contact. Our e-mail may be blocked by your filters; please check your junk e-mail folders
if you have not received an e-mail from us confirming receipt of your application within two weeks of submission.
Home (local) address:
City: State: Zip:
Phone (Home): (Cell): (Work):
Emergency contact: (Name, phone number & relationship) ______
Name of Parent/Guardian if a Minor: Email:
BACKGROUND INFORMATION
Occupation and Employer: Are you retired? Yes No
Education Completed:
Are you a student? Yes No If yes, name of school
Why would you like to volunteer at Dane County Humane Society?
Have you volunteered with a Humane Society in the past? Yes No
If yes, please identify the name of the organization, the time period volunteered and what you did:
Are there any medical conditions that may affect your ability to perform certain tasks? Yes No
If yes, please explain:
Have you ever been convicted of a misdemeanor or felony? Yes No If yes, please explain*:
*All adult applicants will have background checks prior to beginning their volunteer commitment with Dane County Humane Society.
Please mail application to: or send by Fax: (608) 838-0368
Attn: Volunteer Coordinator
Dane County
Humane Society
5132 Voges Road
Madison, WI 53718
Revised 10-17-19
VOLUNTEER INTERESTS Name: ____________________
List the types of pets you have had:
List any additional information or special skills that may be useful as a volunteer, and will aid us in matching you to
the best volunteer position (i.e. training, interests, animal related goals, computer software experience or hobbies):
Most Dane County Humane Society volunteer positions require a minimum six (6) month commitment. Are you able
to commit to six months? Yes No If no, please explain:
Most volunteer positions require a regularly scheduled weekly, two-hour shift. A few positions require a 3-4 hour shift.
We determine your position by matching your interests, experience and availability with our specific needs when you apply. Please
visit our website www.giveshelter.org for information about volunteer positions. Please remember all youths 8-12 years old must be
trained with and volunteer with a parent/guardian. Youth 13-15 must be trained with a parent/guardian before volunteering alone.
Please identify by degree of interest - three to six positions that you would be interested in volunteering your time
in at the shelter, with “1” your first choice, “2” your second choice………and “6” your last choice.
Tuesday
Wednesday
Thursday
Friday
Saturday
8-10am
10am - noon
noon - 2pm
2-4pm
3-5pm
5-7pm
VOLUNTEER APPLICATION AGREEMENT: I certify that the statements made in this volunteer application are true and have been given
voluntarily. I understand that this information may be disclosed to any party with legal and proper interest, including for such purposes as
criminal background checks, and I release the agency from any liability whatsoever for supplying such information. I also understand that I will
not be paid for my services as a volunteer. In consideration of Dane County Humane Society accepting my application, or my child's, for
participation in its programs, I agree to release and hold harmless Dane County Humane Society from and against any and all loss, damage,
claims, liability, costs and expenses of any nature whatsoever, including without limitation, attorney's fees and disbursements, arising from or
occasioned by my participation in Dane County Humane Society programs. I understand there are certain risks inherent in handling animals and
I accept these risks. I agree that Dane County Humane Society may photograph my participation in this program and I hereby release any such
photographs to Dane County Humane Society for use in its programs, publications and purpose.
• I agree to pay a $20 non-refundable fee if I choose to become a volunteer at the volunteer orientation. __________ (Initials)
Applicant Signature: Date:
(You must be at least 18 years of age to volunteer without parent/guardian consent. If the applicant is under 18, parent/guardian must also sign in the space below)
Parent/Guardian Signature of a Minor Applicant: Date:
Admitting Assistant
Administrative Assistant
Adoption Center Assistant
Adoption Pick-up Assistant
Animal Medical Services Assistant
Barkins’ Donation Asst. (Min. age 16)
Bather & Groomer (Professional exp. req.)
Building & Grounds Maintenance Asst.
Kennel Assistant
Pet Profile Writer (Exp. req.)
Photography Asst. (Exp. req.)
Reception Asst. Front Office
Reception Asst. Lost & Found
Thrift Store Asst-West (Min. age 10 w/adult)
Wildlife Assistant
Wildlife Reception
Whatever is needed the most!
Canine Companion
Carestaff Assistant
Classroom Animal Asst. (Min. age 8 w/adult)
Critter Cuddler - Main (Min. age 8 w/adult)
Crit Cuddler - Mounds Fitchburg (Min. age 8 w/adult)
Customer Experience Assistant
Feline Friend - Main (Min. age 16)
Feline Friend - Mounds Sun Prairie
FIT Feline Caretaker (Care for cats w/ringworm)
or scan and email signed
application to:
volunteer@giveshelter.org
Check ALL days and times, you are available to volunteer below. Note: greater availability increases your opportunity to volunteer.
Note: If a minimum age is not listed for the positions above, it is 18.
Note: All positions are at our main Madison location: 5132 Voges Rd. unless an alternate location is listed.
Sunday
Please mail application to:
Attn: Volunteer Coordinator
or send by Fax: (608) 838-0368
Dane County Humane Society
5132 Voges Road
Madison, WI 53718
Revised 10-17-19
Please answer the following questions, and submit with your application: _____________________
Name
Do you have a court-ordered community service requirement? Yes No
Dane County Humane Society does not accept court-ordered community service. If you choose to volunteer your
volunteer time will not be applied to community service hours.
Do you need to complete school or work community service? Yes No
Dane County Humane Society will provide a letter if requested, of community service after the minimum
commitment of six months, volunteered in weekly two-hours shifts has been completed.
Are you younger than 18 years old? Yes No
The minimum age to volunteer is 8 and volunteers between the ages of 8 and 12 must be trained with and
volunteer with a parent/guardian at all times. There are only a few volunteer positions available for youth under 16
years old. DCHS has limited opportunities for youths 13-17 to volunteer solo. If a minimum age is not listed on the
volunteer positions on the application, it is 18 years old. A separate volunteer application must be filled out for the
parent/guardian and each youth interested in volunteering.
Main Shelter Youth Volunteer Opportunities - located at 5132 Voges Road in Madison
Barkins’ Donation Assistant – minimum age 16
Classroom Animal Assistant – minimum age 8 with adult
Critter Cuddler – minimum age 8 with adult (Must be 13 to volunteer solo)
Education Assistant – minimum age 16
Event Volunteer – minimum age 8 with adult (Must be 16 to volunteer solo)
Feline Friend – minimum age 16
Youth volunteers between the ages of 8 and 17 years old have restricted hours at the Main shelter due to our employment of
Oregon Correctional non-violent work release inmates. Shift openings are variable but would occur between the hours of:
3:00 - 7:00pm Monday, Tuesday, Thursday, Friday
3:00 - 5:00pm Wednesday
Noon - 5:00pm Saturday and Sunday (Critter Cuddler or Classroom Asst. with an adult can start as early as 8:00am)
Satellite Location Youth Volunteer Opportunities:
Mounds Pet Food Warehouse - East location, 2110 South Stoughton Road
o Critter Cuddler – minimum age 8 with adult (Must be 18 to volunteer solo)
Are you involved with a vocational rehabilitation organization? Yes No
Name of Organization: Lead Contact:
Lead Contact Email: Lead Contact Phone:
Will you have a job coach? Yes No, What is job coach’s name?
Are you a job coach? Yes No, What is client’s name?
If you are involved with a vocational rehabilitation organization that provides job coaches to assist people
with physical or learning disabilities you must contact Dane County Humane Society prior to filling out a
volunteer application. Job coaches must be trained with and volunteer with their client at all times. Job
coaches are responsible for maintaining a 6 month once per week two hour commitment as they will be the
one’s doing all of the animal handling. Volunteer opportunities will be based on client abilities.
Do you have transportation? Yes No
The main location of Dane County Humane Society, at 5132 Voges Rd in Madison is not easily accessible by public
transportation. If you rely on public transportation, select the West Side location or a Mounds Adoption Center that
is on the bus line for your volunteer position. You will need to attend a Volunteer Orientation, and in some cases
position assignment training at the Main shelter.
or scan and email signed
application to:
volunteer@giveshelter.org
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Dane County Humane Society Volunteer Application

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Completed 8 January 2021

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