HAPPY TAILS DAY

VOLUNTEER

RSPCA WA Happy Tails Day Volunteer Application Form

Thank you for you interest in becoming a volunteer for the RSPCA WA. Please complete and return the following
application form. All information provided on this form will remain strictly confidential.

Personal Information

Name:_______________________________________________________________________________________________

Address:_________________________________________Suburb:___________________________ Postcode:__________

Home Phone:______________________ Work Phone:______________________ Mobile:____________________________

Email:_________________________________________________ Date of Birth __________________________________

In case of Emergency

Please provide details of a person we should contact in the event of an emergency.

Name:________________________________________Relationship:____________________________________________

Contact phone number:________________________Second contact phone number:_______________________________

Available Roles and Shifts

Please tick the boxes of the area you would like to work along with the day and time you are able to commit to:

Time Subiaco Time Perth City

(tick) (Set up in front of post office on Rokeby Road) (tick) (Set up in the Kiosk location in Murray Street Mall)

Friday, 9th October

8.00am -11.30am (set up) 5.30am – 8.00am
11.30am – 3.00pm 8.00am – 12.00pm
12.00pm – 4.00pm

Other (please write details): ____________________________________________________________________________

____________________________________________________________________________________________________

Declaration
In participating as a volunteer you acknowledge that you understand the activities and risks involved and agree, in
consideration of permission to participate in the activities, to release and indemnify RSPCA WA (inc), its officers, employees
and volunteers (be they individuals or organizations, singularly or collectively) from and against all liabilities, claims,
damages, suits, expenses cause of action, injuries, losses or inconvenience of any description whatsoever arising in any way
from your participation as a volunteer.

I, _____________________________ have read and understood the responsibilities and obligations and the declaration, I
confirm that the details I have provided are true to the best of my knowledge.

Signed _________________________ Date _____/_____/______