3. 
6. 
8. Date*
   Date
10. Last Name*
11. First Name*
12. MI
14. Address*
16. City*
17. State*
18. Zip Code*
20. Email Address*
22. Cell Phone
23. Home Phone
27. Please, provide your age if you are under 18 years of age:
28. Birth Date
30. 
32. Briefly explain why you want to volunteer at the Blount County Animal Center:
34. What kind of pets do you have at home?
35. and how many?
37. As a volunteer, are you willing to commit 2 hours weekly?

    1. Yes

    1. No
38. 

40. Tell us where you wish to volunteer at the Center. We offer opportunities in the Cattery, walking large or small dogs, administration/clerical, Adoption Coordinators, transport, general cleaning, laundry/dishes, photography, and/or vetting (volunteering in Vetting requires some prior training and experience).

42. 1st Choice*
43. 2nd Choice*

45. The Centers Coordinators/Trainers are assigned to different sections where Volunteers work. Once you select where you want to volunteer, you will be assigned a Coordinator/Trainer to assist you through the processes.

47. 
49. 1) I am becoming a BCAC Volunteer of my own free will and take any risks knowingly and by choice*
51. 2) I acknowledge that there are potential risks to my person and property while caring for animals at BCAC. These risks include, but are not limited to bites, scratches, zoonotic diseases, and allergic Reactions. I acknowledge that there is a potential of an allergic reaction to cleaning and laundry products used at BCAC.*
53. 3) I agree to hold harmless the Blount County Government, its officers, employees, and agents from any and all claims made by me arising from volunteering at the BCAC, or at any BCAC events.*
55. 4) I hereby waive and release the Blount County Government, its officers, employees, agents, and Representatives from any and all liability of any nature for injury or damage which I may suffer, Including specifically, but without limitation, any injury or damage to me resulting from the action of any animals, or the actions of the BCAC, its employees, agents or volunteers. I expressly assume the risk of such damage or injury while volunteering on the premises of the BCAC or the premises of any BCAC sponsored events. This waiver will remain in full force for the duration of my association with the BCAC.*
57. 5) I understand this is a voluntary position, that I am not required to volunteer and that I am agreeable to this waiver as a condition of my being allowed to volunteer at BCAC*
59. 6) I agree to abide by the rules and procedures presented to me during orientation at all times while Volunteering at the BCAC facility or at BCAC events.*
61. 7) I acknowledge that my image may be captured while volunteering for BCAC, and I give my permission to BCAC to use any images or videos taken of me for public use.*
65. 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.
67. Volunteer Name Print*
68. Date*
    Date
70. Volunteer Name Signature
71. Date
    Date
75. Parent/Guardian Name Print

    For Volunteers Under 18 Years of Age

76. Date
    Date
78. Parent/Guardian Signature

    For Volunteers Under 18 Years of Age

79. Date
    Date
Leave This Blank:


81. 1. Receive an email copy of this form.
82. Email address

    This field is not part of the form submission.

83. Submit

* indicates a required field