Pet Harbor Rescue & Referral, Inc.
. . . a port in the storm located in Virginia for homeless Siberian Huskies and cats. . .
(703) 583-HSKY


Guidelines
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FAQ
Adult Volunteer Application
PLEASE NOTE: YOU MUST BE AT LEAST 18 TO APPLY. If you are 14-17, please ask our volunteer coordinator for a minor volunteer application.

Thank you for your interest in Pet Harbor Rescue. Please review our Volunteer Guidelines first. Our rescue is a nonprofit organization which operates an animal rescue organization for dogs, particularly Siberian Huskies, & cats. Volunteers with a variety of skills are needed. Please take the time to complete this application & agreement & return it to us. Do one application per volunteer. After we review your information, our volunteer coordinator will contact you regarding your availability to volunteer & the activities in which you have expressed interest. Please direct questions to our volunteer coordinator.
Have you read and do you understand and agree to the guidelines?

As a volunteer, privileged and confidential information, such as adopter or applicant contact information, may be released to you for use strictly in the course of your duties as a Pet Harbor volunteer. Do you understand all such information to which you are a custodian may not be divulged to anyone, including other Pet Harbor volunteers, for any reason whatsoever and may only be used for the professional and limited Pet Harbor purpose it was intended?

Do you agree to maintain the highest level of confidentiality of such information and remove it from your possession as soon as you have completed the task for which you were given such information?

Do you understand volunteering has absolutely no influence whatsoever on any adoption decisions and that should you apply to adopt, your adoption application may be rejected?
Part I - Application:

Name

E-mail

Address
(Include city, state, zip, & county)


Home Phone
 Work Phone

Cell Phone
 Occupation

Birth Date
 Driver's License # & State

Preferred method of contact for volunteer opportunities
To find out what volunteer opportunities are available, we have an ongoing e-mail loop! All volunteers are signed up to the listserv, which also gives updates on pets adopted as well as available opportunities. What e-mail address would you like to use on the listserv?
References:

ONE MUST BE YOUR VET. PLEASE DO NOT LIST PEOPLE WHO HAVE PRIVACY BLOCK ON THEIR PHONES.
1 2 3
Name Name Name
Relationship Relationship Relationship
Phone Phone Phone
E-mail E-mail E-mail
Affiliations:
List your animal organization memberships (if any) with telephone numbers and positions held.
Have you been a committee chairperson?
Committees and years served:
Interests:
Are there areas of animal care-taking that particularly interest you?
Please describe.
Are there areas of animal care-taking in which you would not participate?
Please describe.
Are there areas of animal care-taking in which you have particular knowledge or expertise?
Please describe.
What types of volunteer work would you like to do?
What attributes do you think you can bring to Pet Harbor? For example, if you are a particularly organized person, this is where you tell us.
Which hours and days of the week can you volunteer? (We understand this does not mean EVERY instance. For example, if you write "Saturday morning," we understand that does not mean EVERY Saturday morning.)
Do you have animal allergies?
Are you willing to make long distance telephone calls and have free long distance (such as Verizon Freedom)?
Do you have a vehicle you are willing to use to transport pets?
Please describe your geographical limitations in driving.
Pets:
Do you presently own a dog or cat?
Please describe. Space provided to list 4. Please indicate any additional pets under "Comments."
The 1 st pet is: How long have you had this pet?
Description (Include name, breed, sex, age)
(Example: Fido, male Lab mix, age 4)
Is the pet neutered or spayed? If the pet is not fixed, please provide the reason.
Where did you get the pet?
(Example: Lab rescue)
The 2 nd pet is: How long have you had this pet?
Description (Include name, breed, sex, age)
(Example: Fido, male Lab mix, age 4)
Is the pet neutered or spayed? If the pet is not fixed, please provide the reason.
Where did you get the pet?
(Example: Lab rescue)
The 3 rd pet is: How long have you had this pet?
Description (Include name, breed, sex, age)
(Example: Fido, male Lab mix, age 4)
Is the pet neutered or spayed? If the pet is not fixed, please provide the reason.
Where did you get the pet?
(Example: Lab rescue)
The 4 th pet is: How long have you had this pet?
Description (Include name, breed, sex, age)
(Example: Fido, male Lab mix, age 4)
Is the pet neutered or spayed? If the pet is not fixed, please provide the reason.
Where did you get the pet?
(Example: Lab rescue)
Comments
Please let us know any other information you wish us to consider in matching you with volunteer tasks. Here is your chance to personalize this application. Information you may think doesn't matter might very well help us match your desires/talents with the right positions.
By indicating yes and submitting this form, I signify that all information given in this application is true and correct, to the best of my/our knowledge.
Part II - Agreement:

In consideration of this opportunity to volunteer, I agree to the following terms and conditions, intending to be legally bound by them:

1. I will abide by the mission, rules, regulations, policies, and programs of Pet Harbor Rescue & Referral, Inc. (hereinafter "Pet Harbor") while I am a volunteer.

2. If I discontinue being a volunteer for Pet Harbor for any reason or upon Pet Harbor's request at any time, I will promptly return all of Pet Harbor's supplies, equipment, records, monies, and other items in good, clean condition.

3. I assume the risks of being bitten, scratched, injured, or frightened by cats, kittens, dogs, and puppies in connection with my volunteer work for Pet Harbor. Pet Harbor is not liable to me for any injuries, damages, liabilities, losses, judgments, costs, or expenses whatsoever which I might suffer or sustain in connection with the performance of my volunteer activities for Pet Harbor unless they are the result of Pet Harbor's gross negligence or intentional misconduct. I will indemnify, defend, and hold Pet Harbor harmless from and against any claims, lawsuits, injuries, damages, losses, costs, or expenses whatsoever sustained by any companion animal or any person in connection with my intentional misconduct or grossly negligent performance of volunteer activities for Pet Harbor or my breach of Pet Harbor's rules, regulations, policies, and programs.

4. I understand and agree that Pet Harbor may refuse volunteer applications for any reason.

5. I have accurately and truthfully completed this volunteer application and agreement.

6. Any modification to this agreement must be in writing signed by both parties. This agreement is binding upon me and my respective heirs, successors, assigns, executors, and personal representatives.
Signature

Part III - Statement:

To all Volunteers:

A new Virginia law went into effect on October 1, 2008 requiring all “home-based rescues,” which would include Pet Harbor within its definition, to obtain signed statements from anyone adopting from, volunteering with, or connected to us in any capacity that the individual “has never been convicted of animal neglect, abandonment, or cruelty.” Attached here is the statement. You must sign this before volunteering in any capacity. Specifically, the law is Virginia § 3.2-6546(D)(1).

We appreciate your cooperation.

Pet Harbor Board of Directors

STATEMENT REQUIRED BY VIRGINIA LAW [Code § 3.2-6546(D)(1)]

I attest that I am connected with a home-based rescue as defined under Virginia law, specifically Pet Harbor Rescue and Referral, Inc., as a volunteer. I further attest that I have never been convicted of animal neglect, abandonment, or cruelty.

PET HARBOR WOULD LIKE TO THANK YOU FOR TAKING
THE TIME TO COMPLETE THIS APPLICATION.
Good Dogs and Cats Deserve Second Chances