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2. First Name*
3. Last Name*
4. Date of Birth*
   Date of Birth
6. Address*
7. City and State*
8. Zip Code
10. Phone Number*
11. Additional Phone Number
13. Email Address
14. Occupation*
18. Contact in case of emergency
20. Name*
22. Phone Number*
23. Alternate Phone Number
25. Please list any allergies
27. Do you have any medical condition of which we should be aware? If so, please describe.*
31. Do you have any pets?*
    -- Select One --YesNoNot currently but have previously
32. If so, what kind?*
34. Are your animals currently vaccinated?*
    -- Select One --YesNo
35. Veterinarian*
37. Have you volunteered before?*
38. If so, where?
40. How did you hear about the North Attleboro Animal Shelter?
42. What interested you in becoming a volunteer for us?*
44. In which activities would you like to participate?*

    1. Walk Dogs
    2. Cleaning Cages
    3. Animal Socialization

    1. Computer/Office Work
    2. Phone Work
    3. Adoption Events

    1. Community Events
    2. Group Volunteer Activities
    3. Bottles & Cans

    1. Fundraising
    2. Facilities Management
    3. Other
48. Hours available to volunteer:
50. Monday:*
    Monday: Start Time

    —

    Monday: End Time
52. Tuesday:*
    Tuesday: Start Time

    —

    Tuesday: End Time
54. Wednesday:*
    Wednesday: Start Time

    —

    Wednesday: End Time
56. Thursday:*
    Thursday: Start Time

    —

    Thursday: End Time
58. Friday:*
    Friday: Start Time

    —

    Friday: End Time
60. Saturday:*
    Saturday: Start Time

    —

    Saturday: End Time
62. Sunday:*
    Sunday: Start Time

    —

    Sunday: End Time
64. Please Read and Sign Below

    I, being over the age of 18, am volunteering to perform service work for the Town of North Attleborough. In consideration of being allowed to perform this volunteer service, I do hereby release the Town of North Attleborough and its officials, officers, agents, and employees from liability for any harm, injury or damage which I may suffer, sustain, and/or incur while in the course of performing the volunteer work which is assigned. This release applies to all risks which are connected with this work whether foreseen or unforeseen. I do understand the supervisor responsible for directing the volunteer work will make an effort to inform me of the general hazards involved with the work to be undertaken. This release applies to damages suffered by me, by myself as well as my family, heirs, and assigns as a result of any harm or injury which I may suffer.

    I agree to hold the Town of North Attleborough and its officials, officers, agents and employees harmless from any claims made by myself, my family, estate(s), heirs, or assigns out of my volunteer service for the Town of North Attleborough.

    I further agree I shall hold harmless, indemnify and defend the Town of North Attleborough, its officials, officers, agents and employees from any damage to persons or property, resulting from my negligence and/or intentional acts.

    I further assume the responsibility of the physical fitness and ability to perform the work which is assigned to me. If I do not feel I am capable of performing the volunteer work assignment, I shall assume the responsibility of informing the volunteer services coordinator.

    I am of lawful age and legally competent to sign this release and have signed this document as my free act.

    I have fully informed myself of the contents of this release by reading it by signing it. I realize that by signing this document I am giving up legal rights which I may be entitled to. 

66. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
68. Electronic Signature
69. Date*
    Date
Leave This Blank:


71. 1. Receive an email copy of this form.
72. Email address

    This field is not part of the form submission.

73. Submit

* indicates a required field