PACIFIC COVE HUMANE SOCIETY

Volunteer Application

Pacific Cove Humane Society (PCHS) is an all-volunteer, nonprofit organization that is dedicated to creating a new pet adoption and care center for the Coos County region at our recently acquired building on Vine St. in Coos Bay. Remodeling and refurbishing the structure is the next phase in achieving our goal. Once completed, the center will be a valuable community resource, a place where people can learn about pet care, receive guidance in choosing the pet that is best for them, and where the animals are cared for in a modern, humane environment. Join us in creating a special place where animals are given a helping hand and a way back to a loving home.

To accomplish our mission, we rely entirely on our volunteers and the community’s support.  We need volunteers for a variety of positions, including fundraising events, office coverage, publicity and much more. Please complete and sign this form. Thank you for donating your time and talents to Pacific Cove Humane Society.

Name: (Please Print) __________________________________________________________________

Mailing Address: ________________________________ City, State, Zip _________________________

Home Phone: __________________________ Work or Cell Phone: _____________________________

E-mail Address: ______________________________________________________________________

Date of Birth: _____________________ Required if under 18 years of age.  Volunteers under the age of 18 must have parent’s permission; those under 14 years of age must be accompanied by a parent or responsible adult.

Special interests, experience or restrictions (please describe):

____________________________________________________________________________________

____________________________________________________________________________________

Are you acquainted with a current volunteer or member?  Please provide their name and phone number.

______________________________________________________________________________

I understand that as a volunteer of Pacific Cove Humane Society, I will receive no compensation or benefits.  In addition, I understand that I serve at the discretion of PCHS and must conform to the appropriate rules, regulations and agency policies regarding conduct.  I further agree to hold PCHS harmless in all matters relating to my service as a volunteer including, but not limited to, personal injury, loss of property or personal liability regarding my conduct.

I have read and agree to comply with the Volunteer Policy of Pacific Cove Humane Society.

Volunteer Signature: ___________________________________ Date: __________________________

Guardian’s Signature (if volunteer is under 18): __________________________ Date: _______________

For further information contact Marie McKeeman, Pet Adoption Coordinator:  mimigeo2@frontier.com or

Pacific Cove Humane Society: P.O. Box 361 / North Bend, OR 97459 / 541-756-6522 / www.pacificcove.org

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