Court Ordered Community Service Volunteer Application Court Ordered Community Service Volunteer Application Please complete this application form if you are interested in completing court ordered community service at the Heart of the Valley Animal Shelter. Once you complete the form, click the submit button at the bottom. Contact Information First Name * Last Name * Address * Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Country Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Côte d'Ivoire Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Barthelemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Country Phone Number * Email * Birthdate * Why Volunteer Please state your offense: HOV does NOT accept volunteers with theft or violence related charges. * Have you been convicted of a felony? * Yes No If yes, please explain. Please provide contact information for who is overseeing your hours. * How many hours of community service do you need to complete? * HOV Agreement and Policies 1. I understand and agree that submitting this application form does not automatically register me as a Heart of the Valley, Inc. (“HOV”) volunteer, and that there may be certain qualifications I must meet, including the acceptance of established volunteer policies and procedures before I may begin volunteering. 2. By submitting this form, I attest that the information I have provided on the form is true and accurate. 3. My services to HOV are provided strictly in a voluntary capacity as a Volunteer without any express or implied promise of salary or compensation of any kind. This would include any employment type benefits, including employment insurance programs, worker's compensation accrual in any form, vacations or sick time or any type of payment. 4. I will familiarize myself and comply with HOV policies and procedures applicable to Volunteers. I will abide by the mission, rules, regulations, policies and programs of HOV while I am a volunteer. In particular, I fully understand that HOV expects high standards of ethical treatment of animals under its care. 5. I fully understand that HOV is an "Open Admission" shelter and how HOV defines and implements this policy. I also understand that HOV may euthanize animals at any time for medical or behavioral reasons, including aggression or quality of life concerns, and agree to respect those decisions. 6. If my application to volunteer is accepted, I agree to be a volunteer for HOV. 7. I understand that information I receive as a volunteer about HOV’s operations, including but not limited to files and records, policies and procedures, information about employees, donors, clients, volunteers or disposition of animals at the shelter, is confidential. I agree that I will not disclose this information without express written authorization from HOV. 8. I understand that HOV is not responsible for any illness or injury caused by any animals that I come into contact with during my volunteer work. I hereby agree and release, indemnify and hold harmless HOV and associated Officers, Directors, Employees, and Agents, including PetSmart and PetSmart Charities, from any and all claims, damages and liability arising from or related to my activities as an HOV volunteer. 9. I understand and agree that the behavior of animals is unpredictable and that some animals are capable of inflicting serious personal injury or death, as well as significant property damage. I acknowledge that while HOV will take every reasonable precaution to minimize the potential of danger posed by the animals under its care, it is never possible to guarantee the temperament and/or behavior of any animal at all times and under all circumstances. I therefore agree that if I choose to walk, handle, foster, or care for any HOV animal, I will do so at my own risk. 10. I understand that HOV, without notice or hearing, may terminate my services as a Volunteer at any time, with or without reason. I will promptly return all HOV supplies, equipment, records, moneys, and other items in good, clean condition. I also understand that I am not guaranteed a position in the Volunteer Program. I REPRESENT THAT I AM OVER EIGHTEEN YEARS OF AGE AND ACKNOWLEDGE THAT I HAVE READ THIS AGREEMENT CAREFULLY AND I FULLY UNDERSTAND ITS CONTENTS AND IMPLICATIONS. I AM AWARE THAT THIS IS A WAIVER AND RELEASE OF LIABILITY AND INDEMNITY AGREEMENT, AND THAT IT IS BINDING AND ENFORCEABLE BY LAW. As a Heart of the Valley Volunteer, I pledge to: Respect: - Respect others even though I may not agree with them. - Display courtesy, sensitivity, consideration and compassion for people and animals. - Use good judgement in recognizing the scope of authority of staff members. Safety: - Keep safety at the forefront of all volunteer activities - Follow the rules presented to me in training - Respect and use equipment and supplies as they are intended - Report all injuries immediately to a staff person Quality - Perform all tasks to the best of my ability - Ask for help when needed - Recognize training is essential to maintain safe shelter practices Self Discipline - Recognize my limitations and those of others - Set boundaries for myself - know my limits with the animals and other activities - Hold myself accountable for the commitments I undertake Communication - Recognize I communicate verbally and non-verbally - Listen to the needs of others - Advise shelter personnel of relevant information regarding the animals and my involvement at the shelter Commitment - Recognize that commitment comes from within - Respect that people and animals count on me to honor my commitments - Work together with staff and other volunteers to meet HOV's goals Welfare - Value my role in the maintenance and growth of the organization - Strive to promote a positive environment - Respect and support all people and animals * I Agree If you are human, leave this field blank. 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