The Farley Foundation, Inc. - Volunteer Application, Agreement and Release of Liability

Thank you for applying to volunteer with The Farley Foundation. Volunteers must be 16 years of age or older. Volunteers under the age of 18 must have the written consent/release of a parent/legal guardian. A parent/guardian must be present for orientation.

Today's Date: / MM / DD YYYY
Name First Last
Email
Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone (day) - ### - ### ####
Phone (evening) - ### - ### ####
Phone (other) - ### - ### ####
Date of birth: / MM / DD YYYY
Medical Conditions in case of emergency:
Emergency Contact in case of emergency (Name and Phone Number(s)
Relationship
Secondary Emergency Contact and phone.
Volunteer and other Relevant Experience:
How did you hear about The Farley Foundation?
What days and hours are you available for volunteer work and what types of work interest you?
Do you wish to volunteer for a specific number of hours?

Do you wish to volunteer for a specific number of hours? Yes No
If yes, how many hours weekly or less often?
Will this volunteer service fulfill a requirement of a school, club or other group?

Will this volunteer service fulfill a requirement of a school, club or other group? Yes No
If so, please name the school, group or agency:
Deadline for completion (if any)
Please describe in detail any physical limitations you may have (all Volunteers working directly with animals must be able to handle and control dogs weighing up to 75 pounds, as determined by the COO):
Have you ever been convicted of a crime other than a minor traffic violation?

Have you ever been convicted of a crime other than a minor traffic violation? Yes No
If yes, please explain (all information supplied is kept confidential)