WEBERCOUNTYANIMALSERVICES 1373N.750W.

Ogden,UT84404 (801)3998244

VOLUNTEERINFORMATION&APPLICATION
Date: Name: (Last)
(First) (Middle)

CurrentAddress:
(Street)

(City) (State) (ZipCode)

Telephone:

Email: SocialSecurity#:

DateofBirth:

DriversLicense(State&#): Ifunder18,Parentorlegalguardian:
(Name) (Name) (Telephone#) (Telephone#)

Emergencycontactinformation: Presentemployerorschool:
Doyouhaveanyphysicalormentalimpairmentthatwouldinterferewithyourvolunteerwork?
Yes No Ifyes,pleaseexplain No

Haveyoueversubmittedaclaimforaworkrelateddisability?Yes
Ifyes,pleaseexplain

Whatspecialskillsorpreviousexperiencedoyouhavethatmayhelpushereattheanimalshelter:

ThankyousomuchforvolunteeringyourtimetohelptheanimalsoftheWeberCountyAnimalShelter.Your timewillbeneededandverymuchappreciated.Pleasecarefullyreadthefollowingparagraphandindicateyour acceptancebelow.

IhavereadandunderstandtheWeberCountyVolunteerGuidelines.IherebyreleaseWeberCountyofallliabilitythatmayarrivewith
myvolunteeractivitieswithWeberCounty.

(Signatureofapplicant) (Nameofminorvolunteer)

Bysigningthisrelease,IacknowledgethatIamthelegalparentorguardianoftheaboveminor.Iherebygivepermissionfortheabove minortovolunteerattheWeberCountyAnimalShelter.IhavereadthevolunteerstatementandagreementformandIherebyrelease WeberCountyofallliabilitythatmayarrivewiththeabovenamedminorsactivitieswithWeberCounty.

(Signatureofparentorlegalguardian) (Witness)

WEBERCOUNTYANIMALSERVICES

APPLICATIONFORVOLUNTEERBACKGROUNDCHECK
WAIVEROFLIABILITYRELEASEOFINFORMATION
Name:________________________________________________Dateofbirth:_________________________ Othernamesyoumaybeknownby:______________________________________________________________ IherebyauthorizetheWeberCountyAnimalServicestoconductabackgroundinvestigationandtosolicitfrom applicableagenciesanyinformationwhichconcernsmypastandpresentstatus. Thereleaseofanyandallinformationisauthorizedwhetheritisofrecordornot,andIdoherebyreleaseall persons,firms,agencies,companies,orgroupsfromanydamagesresultingfromprovidingsuchinformation.
Signature: Date: