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2. First Name (of minor)*
3. Last Name (of minor)*
4. Date of Birth*
   Date of Birth
6. First Name (of parent/guardian)*
7. Last Name (of parent/guardian)*
9. Address*
10. City and State*
11. Zip Code
13. Phone Number*
14. Additional Phone Number
16. Email Address
17. Occupation*
21. Contact in case of emergency
23. Name*
25. Phone Number*
26. Alternate Phone Number
28. Please list any allergies
30. Do you have any medical condition of which we should be aware? If so, please describe.*
34. Do you have any pets?*
    -- Select One --YesNoNot currently but have previously
35. If so, what kind?*
37. Are your animals currently vaccinated?*
    -- Select One --YesNo
38. Veterinarian*
40. Have you volunteered before?*
41. If so, where?
43. How did you hear about the North Attleboro Animal Shelter?
45. What interested you in becoming a volunteer for us?*
47. In which activities would you like to participate?*

    1. Walk Dogs
    2. Cleaning Cages
    3. Animal Socialization

    1. Computer/Office Work
    2. Phone Work
    3. Adoption Events

    1. Community Events
    2. Group Volunteer Activities
    3. Bottles & Cans

    1. Fundraising
    2. Facilities Management
    3. Other
51. Hours available to volunteer:
53. Monday:*
    Monday: Start Time

    —

    Monday: End Time
55. Tuesday:*
    Tuesday: Start Time

    —

    Tuesday: End Time
57. Wednesday:*
    Wednesday: Start Time

    —

    Wednesday: End Time
59. Thursday:*
    Thursday: Start Time

    —

    Thursday: End Time
61. Friday:*
    Friday: Start Time

    —

    Friday: End Time
63. Saturday:*
    Saturday: Start Time

    —

    Saturday: End Time
65. Sunday:*
    Sunday: Start Time

    —

    Sunday: End Time
67. Please Read and Sign Below

    For volunteers who are under 18:

    I/we, being the parent(s) and/or legal guardian(s) of the minor, do herbyconsent to allow the minor to perform volunteer service work for the Town of North Attleborough. In consideration of being allowed to perform this

    volunteer service I/we do hereby release the Town of North Attleborough and its officials, officers, agents, and employees from liability for any harm, injury or damage which may suffer, sustain, and/or incur while in the course of performing the volunteer work which is assigned. This release applies to all risks which are connected with this work whether foreseen or unforeseen. I/we do understand the supervisor responsible for directing the volunteer work will make an effort to inform of the general hazards involved with the work to be undertaken. This release applies to damages suffered by myself/ourselves as well as my/our family, heirs, and assignsas a result of any harm or injury which or I/we may suffer.

    I/we agree to hold the Town of North Attleborough and its officials, officers, agents, and employees harmless from any claims made by myself/ourselves, my/our family, estate(s), heirs, or assigns out of the minor’s volunteer service for the Town of North Attleborough. 

    I/we further agree I/we shall hold harmless, indemnify and defend the Town of North Attleborough, its officials, officers, agents, and employees from any damage to persons or property, resulting from the minor’s negligence and/or intentional acts. 

    I/we further assume the responsibility of the physical fitness and ability to perform the work which is assigned to the minor. If I/we do not feel the minor is capable of performing the volunteer work assignment, I/we shall assume the responsibility of informing the volunteer services coordinator.

    I/we am/are of lawful age and legally competent to sign this release as the legal guardian(s) of the minor and have signed this document as my/our free act. 

    I/we have fully informed myself/ourselves of the contents of this release by reading it by signing it. I/we realize that by signing this document I/we am/are giving up legal rights which I/we may be entitled to.

69. 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.
71. Electronic Signature (volunteer)*
73. Electronic Signature (of parent/guardian)*
74. Date*
    Date
Leave This Blank:


76. 1. Receive an email copy of this form.
77. Email address

    This field is not part of the form submission.

78. Submit

* indicates a required field