Personal Information

Name

Email

Date of Birth

Cell Phone Number

Home Phone Number

Address

Work Phone Number

Employer

May we contact you at work?

Preferred method of contact

If you are a student, where do you attend school?

Do you have a valid driver's license?

Have you ever been convicted of a felony?

If yes, please explain:

Volunteer Activities

Why are you interested in volunteering for Star of the North Humane Society?

Please check the volunteer activities in which you would be most interested.

Please tell us about other ways you can help or any special skills you think might be useful for Star of the North activities:

Please explain any physical limitations that might prevent you from doing any tasks:

Please note the days and times you are available:

Your Own Pets

If you have pets, please list their names, ages, breeds, and genders.

Please list your pet's regular veterinarian:
Name

Clinic

Phone

References

List a reference who is not a family member.
Name

Phone

Relationship to you

List a second reference who is not a family member.
Name

Phone

Relationship to you

Where did you hear about Star of the North Humane Society?

I give my permission for Star of the North Humane Society to verify any of the information given by me.

Waiver

In consideration of the services of STAR OF THE NORTH HUMANE SOCIETY, their employees, directors, agents, owners, officers, volunteers, participants, and all other persons or entities acting in capacity on their behalf (hereinafter collectively referred to as "STAR OF THE NORTH HUMANE SOCIETY"), and for other good and valuable consideration, I hereby agree to release and discharge them from liability arising from negligence, on behalf of myself, my children, my parents, my heirs, assigns, personal representative and estate as follows:

1) I acknowledge that animal rescue operations entail known and unanticipated risks which could result in physical or emotional injury, paralysis, death to myself and other persons, and also to property damage. Risks include, among other things: bites, scratches, torn skin, bruises, and damaged clothing or other property. I understand that such risks simply cannot be eliminated without jeopardizing the essential qualities of the activity.

Please check the box if you read and understand statement #1.
I understand

2) I expressly agree and promise to accept and assume all of the risks existing in this activity or as a result of contact with or adoption of an animal. My participation in this activity is purely voluntary, and I elect to participate in spite of the risks.

Please check the box if you read and understand statement #2.
I understand

3) I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless STAR OF THE NORTH HUMANE SOCIETY from any and all claims, demands, or causes of action which are in any way connected with my participation in this activity, my use of their equipment or facilities, my adopting an animal, or my volunteering at this animal rescue operation, arising from negligence. This release does not apply to claims arising from gross negligence or intentional conduct. Should STAR OF THE NORTH HUMANE SOCIETY or anyone acting on their behalf, be required to incur attorney's fees and costs to enforce this agreement, I agree to indemnify and hold them harmless for all such fees and costs.

Please check the box if you read and understand statement #3.
I understand

4) I certify that I have adequate insurance to cover any injury or damage I may cause or suffer while participating, or else I agree to bear the costs of such injury or damage to myself. I further certify that I have no medical or physical conditions which could interfere with my safety in this activity, or else I am willing to assume - and bear the costs of - all risks that may be created, directly or indirectly, by any such condition.

Please check the box if you read and understand statement #4.
I understand

5) In the event that I file a lawsuit, I agree to do so solely in the state of MINNESOTA, and I further agree that the substantive law of that state shall apply in this action without regard to the conflict of law rules of that state.

Please check the box if you read and understand statement #5.
I understand

6) I agree that if any portion of this agreement is found to be void or unenforceable, the remaining portion shall remain in full force and effect.

Please check the box if you read and understand statement #6.
I understand

7) By signing this document, I agree that if anyone is hurt or property is damaged during my participation in this activity, I may be found by a court of law to have waived my right to maintain a lawsuit against the parties being released on the basis of any claim for negligence from which I have released herein. I have had sufficient time to read this entire document. I have read and understood it. I have had an opportunity to contact and consult with legal counsel prior to signing this agreement. I agree to be bound by its terms.

Please check the box if you read and understand statement #7.
I understand

I certify that the information I have provided is true and accurate. I understand that any false information may result in me not being able to volunteer with Star of the North Humane Society. I further understand that Star of the North Humane Society reserves the right to dismiss any volunteer that does not carry out their responsibilities appropriately.

PARENT OR GUARDIAN ADDITIONAL INDEMNIFICATION (Must be completed for participants under the age of 18)
In consideration of:
Minor's Name and Age

being permitted to participate in the animal rescue operations, the adoption of an animal, or other SNHS activities, I further agree to indemnify and hold harmless STAR OF THE NORTH HUMANE SOCIETY from any and all Claims which are brought by, or on behalf of Minor, and which are in any way connected with such use or participation by Minor.

Signature and Date

Signature

If you are filling this form out online, please type your name in the box above.