Volunteer Application If you are a human and are seeing this field, please leave it blank. Date First Name Last Name Address City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip / Post Code Email Phone Occupation: (not required) Do You Own Dogs? Yes No Do you have previous volunteer experience with an animal rescue/shelter/homeless shelter or other organizations/charities? (not required to volunteer) How did you hear about us? What appeals to you about the work Nina’s Network is doing in the community? Volunteers must be 18 years of age or older. Volunteers have a basic understanding of animal handling and will let NN know of any limitations. Volunteers will let NN know of any physical or medical limitations (pregnancy, back problems, etc.) they have prior to working. Do you have any physical or medical limitation which would limit the type of volunteer activities you can do?* Yes No If yes, please explain: Do You Have Health Insurance? Yes No If yes: name of insurance company: At times we need help transporting animals to and from veterinary appointments. Please answer the following questions: Are you willing to transport animals as part of your volunteer work? Yes No Do you have a valid Fl driver’s license? Yes No Name of Insurance Company: As a volunteer/participant of Nina’s Network, I recognize and acknowledge that there are certain risks of physical injury and I agree to assume the full risk of any injuries, including death, damages or loss which I may sustain as a result of volunteering/participating in any and all activities associated with Nina’s Network. I do hereby fully release and discharge Nina’s Network their officers, agents, servants, and employees from any and all claims from injuries, including death, damages or loss which may accrue to me on account of my volunteering/participating with Nina’s Network.I further agree to indemnify and hold harmless and defend Nina’s Network and their officers, agents, servants and employees from any and all claims resulting from injuries including death, damages and loss sustained by me and arising out of, connected with, or in any way associated with volunteering/participating with Nina’s Network. Photo Release During my volunteer time with Nina’s Network, I understand my photo may be taken at various events. By signing below I also hereby grant Nina’s Network permission to use my likeness in photograph(s) and/or video(s) in any and all of its publications or online, whether now known or hereafter existing. I will make no monetary or other claim against Nina’s Network for the use of the photograph(s) and/or video(s). I have read and understood the foregoing, and I am 18 years of age or older.