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Community Service Application & Agreement

Note: you must be at least 18 years of age to participate in HSHA's Community Service Program.

Filling out the following application and agreement does not mean acceptance into HSHA's Community Service Program. Our Community Outreach Coordinator will reach out to you for next steps upon receiving your application.

Name:

Email:

Address:

City:

State:

Zip:

Home Phone:

Alternate Phone:

ID #:

ID # Type:

Driver's License

State ID

Military

Address on ID (if different from above):

Date of Birth:

Probation/Probation Officer:

Probation/Parole Officer Phone:

Probation/Parole Officer Email Address:

Number of Hours Needed:

Need to be Completed By:

Offense for Which This Service Has Been Assigned:

By signing below, I hereby agree to do my community service for the Humane Society of Harrisburg Area (HSHA) upon the following terms, conditions, and understandings.

My services to HSHA are provided strictly in a voluntary capacity as a community service worker without any express or implied promise of pay, compensation, reimbursement, or other payment of any kind whatsoever.

My services are furnished without any employment-type benefits, including, but not limited to, employment insurance programs, worker's compensation accrual in any form, vacations, or sick time.

I will familiarize myself and comply with HSHA policies and procedures applicable to community service workers. In particular, I fully understand that HSHA expects high standards of moral and ethical treatment of the animals under its care. I will adhere strictly to these standards in my capacity as a community service worker.

I understand that HSHA, without notice or hearing, may terminate my community service at any time with or without reason.

I understand the risk of harm presented by the handling of animals and other community service activities on behalf of HSHA. I further understand that community service activities may place me in situations that could result in injury to me or my person property, due to the unpredictable nature of animal behavior and interaction of animals that come into HSHA's care, custody, and control. On behalf of myself and my heirs, personal representatives, and assigns, I hereby release, discharge, indemnify, and hold harmless HSHA and its directors, officers, employees, and agents from any and all claims, causes of action, and demands of any nature, whether known or unknown, arising out of or in connection with my volunteer activities on behalf of HSHA.

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November 23, 2021 12:20 pm EDT

Community Service Application & Agreement Uploaded by Humane Society of Harrisburg Area - noreply@humanesocietyhbg.org IP 50.76.113.117

November 23, 2021 12:33 pm EDT

Kristi Kleinfelter - kristik@humanesocietyhbg.org added by Humane Society of Harrisburg Area - noreply@humanesocietyhbg.org as a CC'd Recipient Ip: 50.76.113.117

November 23, 2021 12:33 pm EDT