Name
Telephone
Date of Birth
Email
Address 1
Address 2
Town/City
Post Code
Emergency Contact Information (required)
Emergency Contact Name
Relationship to you
Emergency Contact Telephone Number
College / University Details
College / University Name:
Course or Qualification:
Teacher / Placement Coordinator:
Educational Establishments Contact Number:
Educational Representative
I confirm this student is undertaking an approved work placement and am the point of contact between the Educational Establishment and The Destitute Animals Shelter should there be any issues.
Name
Position
Signature
Date
Placement start date:
Placement end date
Why would you like to complete your work placement at The Destitute Animals Shelter?
Reasons why you would like to complete a work placement below
List your experiences below:
Other areas of interest where you would be interested in volunteering:
Do you have any medical conditions, allergies, or support needs that we should be aware of?
Preferred Hours:
I confirm that the information I have provided is accurate to the best of my knowledge.
I understand that my placement will be subject to The Destitute Animals Shelter's
health and safety procedures and supervision requirements.
Tetanus - I understand that working with animals and around equipment,
bedding, fencing, and outdoor environments may expose me to cuts, scratches,
puncture wounds, or bites that could increase my risk of tetanus infection.
I acknowledge that:
The shelter strongly recommends that all volunteers ensure their tetanus
vaccination is current in accordance with NHS guidance.
It is my responsibility to know my own vaccination status and to seek medical
advice from my GP or other healthcare provider if I am unsure whether my
tetanus vaccination is up to date.
I understand that the shelter cannot provide medical advice or determine
whether I require a tetanus vaccination.
I agree to report any bite, scratch, puncture wound, or other injury sustained
while volunteering to a member of shelter management as soon as possible and
to seek appropriate medical attention where necessary.
Zoonotic Disease Risk - I understand that working with animals may expose me to zoonotic diseases. Zoonotic diseases are illnesses that can be transmitted between animals and humans through direct contact, bites or scratches, bodily fluids, faeces, urine, saliva, contaminated surfaces, insects, or airborne particles.
By signing this document, I acknowledge and agree that:
I understand that there is an inherent risk of exposure to zoonotic diseases while volunteering at the shelter.
I have been informed of, and agree to follow, all shelter health and safety procedures, including:
Washing or sanitising my hands before and after handling animals.
Wearing any required personal protective equipment (PPE).
Following cleaning and disinfection protocols.
Reporting any animal bites, scratches, or potential exposures immediately.
I will advise shelter management if I have any medical condition, weakened immune system, pregnancy, or other circumstance that may increase my risk of illness, so appropriate duties can be discussed.
I understand that no measures can completely eliminate the risk of exposure, despite the shelter taking reasonable precautions to maintain a safe environment.
I agree to seek appropriate medical advice if I develop symptoms that may be related to exposure to animals or if I sustain an injury such as a bite or scratch while volunteering.
I understand that volunteering is voluntary, and I accept the inherent risks associated with working around animals, including the potential exposure to zoonotic diseases.
To the extent permitted by applicable law, I release and hold harmless Destitute Animals Shelter, its officers, employees, volunteers, and directors from liability for illness resulting from the ordinary inherent risks of volunteering with animals, except where such illness or injury results from negligence or any liability that cannot legally be excluded.
Student Signature:
Date:
Please be aware that if you are invited for an interview we will require photo I.D. as proof of identity.
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