Date:
___________________________________________________________________
Name:
__________________________________________________________________
Address:
________________________________________________________________
Telephone
Number (s): ____________________________________________________
What area of volunteering would best interest you ?
1st Choice:
_____________________________________________________________
2nd Choice:
_____________________________________________________________
Would you prefer volunteering your time to do something other than what is listed in our 'Volunteers Needed Section'? If so, please explain what duties you would prefer? __________________________________________________________
Approximately how many hours per week ____ month ____ are you available to volunteer your time?
What days of the week would be best suited for you to volunteer?_________
Would you provide a back-up volunteer in the event that you were unable to
fulfill your obligation or commitment? If so, list their information below:
Name: ___________________ Tele: _____________ Relationship_____________
What is your reason for considering to volunteer your time with Holly Help? _____________________________________________________________________
Do you have any prior volunteer qualifications ? If so, please list below:
______
What Organization:
__________________________________________________
Dates of Tenure:
_____________________________________________________
Assigned Duties:
_____________________________________________________
If you were provided with the forms, would you be willing to turn in a Progress & Accountability Report to Holly Help ever month in which you would be required to describe what accomplishments you have made/completed regarding your Holly Help Program? Yes_____ No_____
Please use this space for any additional comments you may have: _____________
_____________________________________________________________________
____________________________________________________________________
DISCLAIMER/RELEASE : As a representative for myself and all other who are connected with this volunteer form, I do agree to release any and all claims for personal injury or property damage of any nature that myself, my family or any others may have against The Holly Help Spay Fund, its members. Its members, volunteers and associates shall not be liable for any or all actions, causes of action, claims, costs, demands, expenses and compensations, on or account of or in any way growing out of, any and all known and unknown personal injuries and/or property damages arising from my volunteer actions with the Holly Help Spay Fund.
NOTE*: All Holly Help Spay-Neuter Fund volunteers are required to maintain personal health insurance coverage at their own expense. Please submit a copy of your insurance card along with this application.
____________________________________ ________________________
Volunteer's
Signature Date
Please Mail Application To:
HOLLY HELP VOLUNTEER FORM
PO Box l264
Bristol, Va.
24203