Community Service Application

Legal Name as it appears on your ID/Driver's License * First Last

Email *

Availability Information
THERE ARE NO WEEKENDS AVAILABLE UNTIL JULY 2017.

Total number of hours you need to complete at IndyHumane:
Please Note - You must be in need of a minimum of 20 Hours to be eligible for this program. *

List exact hours needed. Do not list a range of hours or your application will not be processed.

Location You Would Like to Perform Service Hours

IndyHumane has two locations. Please let us know which location you would prefer to perform your Service Hours.

7929 North Michigan Road is our Main Campus and tasks will not include animal interaction unless you are serving more than 100 hours. Those serving more than 100 hours are eligible to have animal interaction if they complete 2 steps of training. Details will be sent to you in your Confirmation Email.

456 North Holmes is our Low Cost Clinic and will not include any animal interaction. There are only facility upkeep related tasks at this location.

At this location (7929 North Michigan Road 46268), we are able to accommodate service hours during the following times:

Monday through Friday in between the hours of 9-6pm at 2-6 hour intervals per day
Saturday in between the hours of 9:30-6pm at 2-6 hour intervals per day
Sunday in between the hours of 9:30-4pm at 2-6 hour intervals per day

You must be able to start your hours before 3pm.

List times you are available on Mondays *

List times you are available on Tuesdays *

List times you are available on Wednesdays *

List times you are available on Thursdays *

List times you are available on Fridays *

List times you are available on Saturdays *

List times you are available on Sundays *

At this location (456 North Holmes Avenue 46222), we are able to accommodate service hours on Tuesdays and Thursdays in between the hours of 9am-3pm at 2-6 hour intervals per day.

List times you are available on Tuesdays *

List times you are available on Thursdays *

Please record any dates that fall within your availability which you are unable to perform service hours.

Order for Service Information
You are not eligible for this program if you have a felony, theft charge or conviction, or have been convicted of any sexual, violent, or animal cruelty related crimes.
You will need to provide documents supporting your order for service.

Your hours must be court ordered or needed for a class or community group in order to be eligible for this program.

Your application will not be reviewed if there is no valid contact person listed. Do NOT list yourself.
Full Name of Person in charge of overseeing your service hours are completed/ to which you will report completion of hours (Case Worker, Probation Officer, etc): *

Email Address for Person in charge of overseeing your service hours are completed: *

What charge/conviction is the reason you are ordered to perform service hours? Use full words (no initials/abbreviations) to describe the exact charge.
If you are in a Diversion Program, you must list the original crime that was the reason for the arrest. *

Must be at least 5 characters. Currently Used: 0 characters.

You are not eligible for this program if you have a felony, theft charge or conviction, or have been convicted of/charged with any sexual, violent, or animal cruelty/neglect related crimes.

School/Class/Group for which you need hours: *

Teacher/Group Coordinator Name: *

Email Address for Teacher/Group Coordinator: *

Medical/Emergency Information
You should record any information you believe is important for IndyHumane to be aware of in case of an emergency.

Name of Emergency Contact * First Last

Relationship to You *

Email Address for Emergency Contact

Please list medical conditions or allergies: *

Please list medications: *

Volunteer Waiver/Release

Volunteer Release:

I hereby fully and forever release and discharge the Humane Society of Indianapolis, its agents, employees, directors, officers and liability insurance carriers, from all actions, damages or judgments which I have now or in the future against the Humane Society of Indianapolis, for all personal injuries to myself, known or unknown, and/or arising out of activities of myself as a Volunteer of the Humane Society of Indianapolis.

I, the undersigned, have read this release and understand all of its terms and I execute it voluntarily and with full knowledge of it significance.

Photo Release:

I hereby give permission to the Humane Society of Indianapolis to use, without furnishing any consideration therefore, any photographs or videotape footage taken of me while volunteering, for the purpose of advertising, publicity, or public relations.

Typing your name below acts as your electronic signature. *

Parental Signature Needed for Minors. Typing your name below acts as your electronic signature. First Last

Comments/Questions:

IndyHumane

Availability Information THERE ARE NO WEEKENDS AVAILABLE UNTIL JULY 2017.

Location You Would Like to Perform Service Hours

At this location (456 North Holmes Avenue 46222), we are able to accommodate service hours on Tuesdays and Thursdays in between the hours of 9am-3pm at 2-6 hour intervals per day.

Medical/Emergency Information You should record any information you believe is important for IndyHumane to be aware of in case of an emergency.

Volunteer Waiver/Release

Availability Information
THERE ARE NO WEEKENDS AVAILABLE UNTIL JULY 2017.

Medical/Emergency Information
You should record any information you believe is important for IndyHumane to be aware of in case of an emergency.