First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

County

Email*

Home Phone*

Work Phone
x

Cell Phone

Applicants Date of Birth?*

Please provide 2 personal references. Include a phone number where they can be reached.*

What activities would you be willing to do for the animals in the care of Piedmont Pound Paws, Inc. and/or the Piedmont, MO City Pound?
Choose all that apply: Clean Cat House and areas where the cats live. Clean Dog Areas. Other. Socialize the Cats. Socialize the Dogs. Walk Dogs.

What other kinds of things would you like to do for Piedmont Pound Paws, Inc.?*

Are you willing to comply with all policies and regulations that Piedmont Pound Paws, Inc. and the Piedmont MO City Pound must comply with, according to the MO Dept of Agriculture, in order to operate as a licensed rescue and/or shelter/pound, in the state of Missouri?*

Piedmont Pound Paws, Inc. and/or the Piedmont MO City Pound are not making any representations or warranties about an animal's temperament or behavior. I acknowledge and agree that Piedmont Pound Paws, Inc. and/or the Piedmont MO City Pound are not responsible for any injury, damage, or harm caused by a dog or cat that I choose to help with, and I hereby release Piedmont Pound Paws, Inc. and the Piedmont MO City Pound from any and all liability: for any injury, damage, harm, expense, or liability I incur relating to fostering or volunteering for Piedmont Pound Paws, Inc. and/or the Piedmont MO City Pound. I also agree to indemnify Piedmont Pound Paws, Inc. and/or the Piedmont MO City Pound from any and all such claims and to pay, without limitation, any costs related to such injury, damage, or liability, including, in the case of litigation, any attorneys' fees incurred by Piedmont Pound Paws, Inc. and/or the Piedmont, MO City Pound, in their defense. Please type your name and date:*

Please type the date and your name, again, to agree and comply with the requirements to volunteer or foster for Piedmont Pound Paws, Inc. and/or the Piedmont MO City Pound.*

I take full responsiblity for the animal that I am working with, should it get loose from me or get hurt, just as I would if it was my own pet. Please type your full name and date. You will be asked to sign this document in person, as well. We will contact you regarding this application. Thank you.*