SPCA West Michigan SPCA
6806 E. Evanston Avenue
Muskegon, MI 49442

(231) 788-5933
spca@detours.net


Volunteer Application

Volunteer Positions:
• Animal keeper - cats • Donation solicitation • Photographer (digital & 35mm)
• Animal keeper - horses • Education • Special Events (adoptathons, etc)
• Animal keeper - wildlife • Fundraising • Tour Guide
• Animal transporter • Garden and Landscaping • Veterinary Transporter
• Construction • Newsletter Contributor • Others

Personal Information

Full Name:

Preferred Nickname:

Address:

City: State: Zip:

Home Phone: Work Phone:

Email:

I prefer to be contacted at:   Home     Work     E-mail

Marital Status:   Single     Married Birth Date:

Education:(Select highest level completed)
Junior High     High School     Undergraduate     Graduate     Doctorate


Volunteer Position

Which volunteer program are you applying for:
Volunteer (1 or 2 days per week)       Intern (5 days per week)

List 3 positions from above list that you are interested in. List in order of preference.

First choice:  

Second choice:  

Third choice:  

Days you are available:  
Monday     Tuesday     Wednesday     Thursday     Friday     Saturday     Sunday

Time of day you’re available:   From: To:

How many days per week would you prefer to volunteer?  

Are there factors which could affect your availability?

Have you ever been convicted of a felony pertaining to animals?   Yes     No
If yes, please explain:

Year of Last Tetanus Shot:  
Please note: It is strongly recommended that volunteers check with their doctors about receiving a current tetanus inoculation.

Can you perform the essential functions of the position(s) you are volunteering for?   Yes     No
If not, please explain:

Please tell us about any special skills or interests of yours.


Emergency Contact

Name:

Address:

City, State, Zip:

Phone:

Relationship to you:


Current Employment

Are you currently:   Working     Retired     Student     Other

If currently working:
Company Name:

Title: Years of service:

Does your employer offer a time-off program for volunteers?   Yes     No

Does your employer offer a donation matching program?   Yes     No


Volunteer Experience

Organization:

Position Held:

Years of Service:

Organization:

Position Held:

Years of Service:


Volunteer Agreement: General Provisions, Waiver, Hold Harmless and Indemnity Agreement

I have agreed to volunteer some of my available time at the West Michigan SPCA. In consideration of the SPCA accepting me as a volunteer and in acknowledgment of the educational and other benefits received by me as a volunteer I represent and agree to the following:

A.  General Provisions

1.  I will read the material provided by my volunteer program, so I may follow policies, regulations and program procedures for a safe volunteer experience.
2.  I understand that, as a volunteer, I am not an employee of the SPCA, that my involvement will not lead to employment status, and that I will not receive compensation for my services.
3.  I understand that I must operate within the scope of the duties associated with my volunteer position, whether performing those duties on or off SPCA property, as in the case of special events.
4.  I understand that I am a representative of the SPCA and must do my best to present a positive image of the SPCA to those who visit the facilities.
5.  I understand that liability insurance is my responsibility.

B.  Waiver, Hold Harmless and Indemnity:

1.  I fully understand and agree to assume all risks of injury associated with my participation in the SPCA’s volunteer program.
2.  I will defend, indemnify, keep and hold harmless the SPCA, its board members, and other volunteers, from all damages, judgements, expenses (including reasonable attorney fees) costs or liabilities in law or equity suffered because of the injury to or the death of any person or persons, or because of damage to property that may arise out of, or as a consequence of , my negligent or intentional acts while participating in the SPCA’s volunteer program.


Release of Liability - I hereby certify that all information contained in my application is true to the best of my knowledge.


  I have read and understand this application and agree to the above statements.