Volunteer Application Volunteer Form Volunteer Application Broken Tails was formed to provide grants to individuals, including good Samaritans, and animal rescue organizations in Northern Beaufort County, South Carolina. We are targeting people or Rescue organizations who unable to pay for needed emergency medical care for their sick or injured companion/foster animals. Broken Tails is all-volunteer non-profit charity and a fund of the Community Foundation of the Lowcountry (CFL). 98% of our monetary donations are used to help animals. We do not have a permanent facility. We are a small organization and volunteers work independently out of their homes. If you are seeking more group experiences or you want to work directly with animals, you may want to contact the Beaufort County Animal Shelter — (843) 255-5510. Thank you for volunteering. This application should take you about 5-10 minutes to complete. Contact Information Title or Military Ranke.g., Mr, Mrs, Ms, Private, Lance corporalVolunteer Name* First Last Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home Phone*Work PhoneEmail Address* Enter Email Confirm Email AgeNote: BT Volunteers must be 18 or olderEmployer / Supervisor nameJob Title / OccupationAvailabilityHow many hours are you available each month?During which hours are you available for volunteer assignments? Mornings Afternoons Evenings Weekdays Weekends Only on the following days:? Mon Tue Wed Thu Fri Sat Sun Are you volunteering through any other agency (e.g., school, court, community center)??YesNoAgency Name:Contact Person:Number of hours required to volunteer:Special Skills or QualificationsSummarize special skills (e.g., PC, software, graphic designer) and qualifications (e.g., teacher, event planner) you have acquired from employment, previous volunteer work, or through other activities, including hobbies or sports:Previous ExperienceSummarize any previous Broken Tails or volunteer experience:Interests Tell us in which areas you are interested in volunteering (check all that apply)Marketing / Fundraising Fund Raising Marketing Events Grants Lead Generation Testimonials Surveys/Feedback Technical Skills Web - Facebook - Petfinder - Blog Newsletter Production Database Development Digital Photography Writer Statistics reports Training Client Manager Broken Tails Counselor Broken Tails Advocate Broken Tails Photographer Leadership Roles Legal - Govt. Affairs Public Relations Volunteer coordinator/Education General Operations - Purchasing Marketing/Fund Raising Foster Care Program Finance ConvictionsHave you been convicted of a felony or misdemeanor associated with animal abuse or neglect with the last seven (7) years?YesNoPerson to Notify in Case of EmergencyEmergency Contact Name First Last Emergency Contact Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Emergency Contact Home PhoneEmergency Contact Work PhoneEmergency Contact Email Agreement and Digital Signature By selecting 'I Agree' below I hereby agree to accept a position as a volunteer worker for Broken Tails, and in so doing, I agree to comply with all the rules and regulations established by Broken Tails, and I understand that failure to do so may result in my immediate termination as a volunteer. As a volunteer, I agree to do my best to represent Broken Tails to the public in an accurate and professional manner and I will support and advocate all of Broken Tails' policies. I acknowledge that as a volunteer I have not been given the authority to speak on behalf of Broken Tails, and will not, unless I have been given that authority by an authorized representative of Broken Tails. I acknowledge that my services are provided strictly on a volunteer basis, without any pay or compensation of any kind. I assume the risks of being bitten, scratched, injured, or frightened by puppies, dogs, cats, and/or kittens in connection with my volunteer work for Broken Tails. Broken Tails is not liable to me for any injury, damages, liabilities, losses, judgments, costs, or expenses whatsoever that I might suffer or sustain in connection with the performance of my duties with Broken Tails. I will indemnify and hold Broken Tails harmless from any claims, lawsuits, injuries, damages, losses, costs, or expense whatsoever sustained by any animal or person in connection with my misconduct or grossly negligent performance of volunteer activities for Broken Tails or any breach of Broken Tails' rules, regulations, policies or programs. I understand that public relations are an important part of volunteering and I hereby allow Broken Tails to use any photograph or likeness of me in any and all public relations efforts. I have accurately and truthfully completed this application and agree to the above. Date Date Format: MM slash DD slash YYYY By checking this box you have read and agree to the above statements* I agree Captcha
