Liberty Humane Society - Volunteer Application

Liberty Humane Society
235 Jersey City Blvd., Jersey City, NJ 07305
Telephone: 201-547-4147 x 1003
Email: volunteer@libertyhumane.org
www.libertyhumane.org

Thank you for your interest in volunteering at the Liberty Humane Society!

Date *

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Occupation *

Age group: *

15 or under

16-17

>18

Do you have pets? What kind? *

Where did you get your pets? *

How did you hear about our volunteer program? *

Are you a previous LHS volunteer? *

Yes

No No

How long ago did you volunteer with LHS and what was your role? '

Please list any previous shelter or professional animal handling experience (volunteer or paid). Please include organization name, dates of work, and responsibilities.

Please list the days/times that you are available to volunteer: *

	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday
Morning (~10-12)	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday
Afternoon (~12-4)	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday
Evening (~4-7 or after work)	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday

If you were referred to us through an agency for community service, please indicate the agency, name of contact person, and if applicable, the number of hours you are required to volunteer.

Why would you like to become a volunteer with the Liberty Humane Society? *

Are you able to commit a minimum of 8 hours per month to volunteering with LHS? *

Yes

No

Are you interested in working directly with animals? *

Yes

No

Are you more interested in working with: (please remember that you can always change your answer or work with both if you are interested) *

Cats

Dogs

Although we are proactive in placing animals into qualified homes or to rescue organizations, some animals are "unadoptable" and are euthanized (humanely put to sleep). How do you feel about this? *

Do you own or have access to a car? *

Yes

No

Would you like to be added to our transportation list (in order to receive information on when we need help with transportation for various things)? *

Yes

No

Would you like to be added to our flyering list (in order to receive a copy of flyers for adoption events and promotions to print and pass out)? *

Yes

No

Please list any special skills you have that may be of use during your time volunteering at LHS (ex. photography, graphic design, sewing, etc):

Please list at least one contact whom we should notify in case of an emergency (name, relationship, address, phone number): *

Any addotional notes, comments, etc:

As a volunteer with the Liberty Humane Society., I understand the risks involved in working near or with
any animal, including the risk of personal injury. On behalf of myself, my heirs, personal representatives
and executors, I hereby release, discharge, indemnify and hold harmless The Liberty Humane Society,
its agents, servants and employees from any and all claims, causes of action, or demands, of any nature
or cause, including costs and attorney’s fees incurred by the Liberty Humane Society 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 the Liberty Humane Society including, but not limited to, animal bites, property damage, accidents or injuries.

Signature: By typing my name in the field, I am confirming that all information that I have provided is accurate. *