Item X1
BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
Meeting Date: June 16-17,2004
~~
~ ~~ ~~
Louis LaTorre/DirectorlSocial Services
Division: Community Services
BulkItem: Yes _ No X-
Department: Social Services
AGENDA ITEM WORDING: Approval of Pet Friendly Shelters for the Special Needs Clients located in five
shelters throughout Monroe County and one Pet Friendly Special Needs Shelter in Dade County, location to be
determined.
ITEM BACKGROUND: See attached documentation
PREVIOUS RELEVANT BOCC ACTION: N/A
CONTRACTIAGREEMENTCHANGES: N/A
STAFF RECOMMENDATION: Approval
TOTAL COST:
Unknown
BUDGETED: Yes No _X_
COST TO COUNTY: Unknown
SOURCE OF FUNDS:
REVENUE PRODUCING: YES
NO --X-
AMT. PER MONTH
YEAR
APPROVED BY: County Atty. OMBIPurchasing ~ Risk Managuenil
DIVISION DIRECTOR APPROVAL: I{~ ~
James E. Malloch ACTING DIVISION DIRECTOR
DOCUMENTATION:
Included: b To Follow:
Not Required: _
DISPOSITION:
Agenda Item #:
y/
Me Pet-Friendly Special Needs Sheltering Plan
Monroe County Pet-Friendly Special Needs Sheltering Plan
Presented for Monroe County
Board of County Commissioner Review
By:
Monroe County Social Services Department
Louis LaTorre, Director
1100 Simonton Street Room 1-204
Key West, Florida 33040
(305) 292-4573
socialservices@monroecountv-fl.swv
Wednesday, June 16,2004
Me Pet-Friendly Special Needs Sheltering Plan
TABLE OF CONTENTS
I. Overview
II. Hurricane Special Needs and Pet-Friendly Shelter Locations
III. Shelter Staffing
IV. Standard Operating Procedure
V. Shelter Floor Plans
· Harvey Government Center
· Sugarloaf Elementary School
· Stanley Switlik Elementary School
· Coral Shores High School
· Key Largo School
VI. Sheltering forms - Owner
· Emergency Shelter Agreement
· Pet Registration and Agreement
VII. Volunteer forms
· MC Volunteer Application Form (2 pages)
· Disaster Response Volunteer Intake Form
· Animal Relief Volunteer Badges
2
Me Pet-Friendly Special Needs Sheltering Plan
MONROE COUNTY SPECIAL NEEDS PET SHELTERING PLAN
After Hurricane Andrew devastated South Florida in 1992, state emergency
response personnel realized the convergence of animal and people issues
during a disaster. They learned that, under adverse circumstances, the
ultimate safety of many of Florida's citizens depends on the safety of their
pets, domestic and exotic, and the livestock they tend. Until that time,
people in harm's way were told by state emergency management to evacuate
their home, but to leave their pets. Relaying this information has often
created situations where animals were technically neglected and/or
abandoned and it added additional stress to people who evacuate without
their animals. These scenarios produce serious complications for Emergency
Management.
It stands to reason, if humans were at risk from an impending cataclysm, so
were the lives of animals, and visa versa. We now understand that many
people, especially the elderly, simply do not abandon their companion
animals, even in life-threatening situations. In 1994, Governor Lawton
Chiles mandated that all Florida counties provide means to accommodate
animals, domestic and livestock, in times of emergency events. Emergency
protocol ESF-17 is a result of that edict.
Special Needs clients who evacuate to shelter in Monroe County with their
pets may have several options for housing companion animals. Choices
include boarding kennels, veterinarian offices, hotels and motels, and the
designated pet-friendly shelters. It is important that all of these options be
available at any given time during an evacuation.
Whether due to need, lack of planning, or rapid onset of an event that
overwhelms local animal housing options in which even the most
responsible pet owner can be caught in a resources pinch, emergency
sheltering for Special Needs clients be enhanced to include companion
animals. The stress of a disaster for both citizens in general and for
emergency response and management will be alleviated by not encouraging
the separation of owners from their pets and by host locals offering and
marketing as many options to animal owners as possible. In an effort to
provide the service of a pet-friendly emergency shelter in Monroe County
the Special Needs Registry has devised guidelines for the emergency
sheltering of Special Needs Client's animals in Monroe County.
3
Me Pet-Friendly Special Needs Sheltering Plan
Meetings have occurred with various Monroe County employees and
community partners regarding emergency sheltering of pets for Special
Needs clients. The following people have been consulted:
Commissioner Dixie Spehar - Monroe County Commissioner
Jim Malloch - Community Services Director
Jerry Eskew - MC Transportation Senior Administrator
Anna Haskins - Special Needs Registry Coordinator
Jim Timony - Veterans Affairs
Danise Henriquez - MC Tax Collector
Ron Rodamer - Sugarloaf Volunteer Fire Dept.
Brenda Beckmann - MC Trauma Emergency Management
Bill Grumhaus - Risk Management Director
Charles Ingraham - Veterans Affairs Director
Mark Anderson - Harvey Building Facilities Maintenance
Laura Bevan - US Humane Society Tallahassee
Dean Humfleet - FKSPCA Director (Lower Keys Animal Shelter)
CeCe Crane - Kritter Patrol President
Michael Henriquez - MC School Board - Safety Director
Fred Sims - MC School Board - Facilities Director
Alan Roberts - MC School Board - Assistant Director of Facilities
Jim Hall - Assistant Principal Sugarloaf Elementary
Harry Russell Jr. - Assistant Principal Stanley Switlik Elementary
Ron Martin - Assistant Principal Coral Shores High School
Darren Pace - Assistant Principal Key Largo Elementary
Linda Gottwaldt - Middle Keys Animal Shelter Director
Tom and Marsha Garretson - Upper Keys Animal Shelter
Capt. David Worthy - Salvation Army
Jerry O'Cathey - Emergency Management Administrator
Irene Toner - Emergency Management Director
Billy Wagner - Emergency Management Senior Director
Chief Clark Martin - MC Fire Chief
Chief William Wagner - Islamorada Fire Rescue Chief
Chief Hans Wagner - Marathon Fire Rescue Chief
Chief Sergio Garcia - MC Emergency Medical Services
Suzanne Hutton - Assistant County Attorney
Dr. Suzanna May - MC Health Dept Director
This listing is not all-inclusive as many others were contacted for their
involvement, expertise and advice. We relied on agencies throughout the
4
Me Pet-Friendly Special Needs Sheltering Plan
state to gain perspective and gather information regarding the components of
this plan. The County Attorney's Office and Risk Management Department
raised issues regarding discrimination, liability including for cross
ventilation contamination.
· As long as it is clear that the County is not instituting this program as
a permanent service and that it is limited to Special Needs clients in
particularly vulnerable housing, there should not be any problem with
discrimination. This is a trial program which would survive only as
long as it is economically and tactically feasible to provide it to the
specified Special Needs Clients. This is a small enough sector of the
community that the basics can be put in place in order to see if the
program would work. If this trial program is successful and other
issues, such as increased shelter capacity, can be solved, Monroe
County could look at instituting a program for the "general
population" .
· There always is an issue of liability when the County undertakes any
action. Liability in this case can be significantly contained by taking
precautionary measure against injurious contact between people and
pets in shelters, and by requiring both the clients whose animals are
accommodated through this program and the volunteers who work
with the sheltered pets to sign releases or waivers from liability.
· There should be no cross ventilation contamination because the
designated pet areas in each of the shelters would ensure no
"common" air elements. The animals are housed in separate buildings
or units running off a completely separate air handling unit.
The Health Department raised the question of communicable diseases which
has been addressed by separating the pets from the people. Also, the clients
and any workers handling the pets will be provided with the appropriate
sanitation supplies.
As in past evacuations, MC will provide Special Needs Registry (SNR)
Clients with shelter in pre-determined locations throughout the county. In
the event of a category 3, 4, or 5 storm, MC will evacuate the clients by
school bus to Florida International University (FlU) in Miami. An ever-
increasing number of SNR clients refuse to evacuate and leave their pets
behind. Therefore, the following plan addresses this need while not
compromising the safety of the SNR population. Our primary focus is on
the elderly and disabled clients who reside in mobile homes, trailers, RVs,
5
Me Pet-Friendly Special Needs Sheltering Plan
boats and campgrounds as well as those in substandard structures and in
low-lying areas.
In a category 1 or 2 storm, Special Needs clients from the above-specified
types of residences will be permitted to bring their pre-registered pets to
shelter with them. Such clients and their pre-registered pets in a category 3,
4, or 5 storm will be transported out of the county to a location which is still
"to be determined". The pets will be sheltered in an area separate from both
the general population and Special Needs clients without pets. This pet
room will have all of the basic requirements of the regular shelter site. Each
pre-determined room is on a separate air-handler than the other shelter
rooms. This negates the possibility of citizens with allergies to animals
being exposed to allergens that may affect their health. The animals will be
taken care of by animal shelter staff, county staff and volunteers.
In some areas it may be possible to house the owners with their pets.
Obviously this would be ideal because it would nearly eliminate the need for
extra staff. It would also lead to a stress-free environment for the pets and
their owners because they would have someone familiar caring for them. If
at all possible arrangements will be made for the clients to stay with their
pets. However, as it stands now, the clients and their animals will be housed
in separate rooms.
Clients will be required to pre-register their pets and show proof of
vaccinations. They will also be required to provide food and other
necessities, such as medications, for their pets. The pet shall arrive in an
appropriate pet carrier or cage. This is where the pet is to remain throughout
its stay in the shelter. Owners will be permitted to have their animals out of
the cage as needed for brief recreation breaks and relief breaks provided that
the pet is on a leash. The times for these breaks will be determined by the
pet-friendly shelter staff.
Volunteers will be utilized whenever available. Residents from the animal
lovers community are being encouraged to volunteer their time so that we
will have people that are used to handling pets and caring for them.
Following are some of the community resources that have been contacted:
Pet shops, Pet affiliated groups, veterinarians and their staff, pet grooming
establishments, and more.
6
Me Pet-Friendly Special Needs Sheltering Plan
Any problems requiring law enforcement attention will be addressed by the
law enforcement officer available on site. If a law enforcement officer is not
on site the call will be referred to 911 and contact should be made with law
enforcement through the regular channels. The various law enforcement
agencies throughout the keys including Monroe County Sheriff s Office and
Key West Police Department have agreed to have at least one member of
their agency available at each Special Needs site. Health emergencies and
problems will be handled by the EMT/paramedics assigned to the Special
Needs shelters. EMS and the various fire departments throughout the keys
have agreed to have at least one EMT or paramedic available for the Special
Needs Shelters.
7
Me Pet-Friendly Special Needs Sheltering Plan
HURRICANE SPECIAL NEEDS AND
PET SHELTER LOCATIONS *
Kev West Area - Harvey Government Center - 1200 Truman Ave, Key
West.
· Registered Special Needs Residents - Commissioner's Chambers -
2nd floor.
· Pets - Senior Center (to the left of the main building). **
· General Population - Commissioner's Meeting Room
Lower Kevs includine Suearloaf - Sugarloaf Elementary School - 255
Crane Blvd, Sugarloaf Key.
· Registered Special Needs Residents - Cafetorium. ***
· Pets - Locker rooms - Which are located to the left and right of the
weight room. * *
· General Population - Cafetorium
Middle Kevs includine Marathon - Stanley Switlik Elementary School -
3400 Overseas Highway, Marathon.
· Registered Special Needs Residents - Room 106 - Building 10 1 st
floor. ***
· Pets - Room 213 - Building 10 2nd floor. Building 10 is the wing
right across from the Cafetorium. * *
· General Population - Cafetorium
Islamorada Area - Coral Shores High School- 89901 US Hwy 1,
Tavernier.
· Registered Special Needs Residents - Cafeteria - With your back to
US 1 the Cafeteria is the building on the far right of the school. You
walk down the RH sided corridor and you will see the picnic benches.
Behind the benches are the doors. ***
· Pets - Rooms 2-001 and 2-004 - The girls and boys locker rooms. If
you continue down the same corridor that the Cafeteria is located in,
towards the very end you will see the locker rooms on the RH side. **
· General Population - Cafeteria
8
Me Pet-Friendly Special Needs Sheltering Plan
Upper Kevs and Kev Lareo - Key Largo Elementary School- 104801
Overseas Highway, Key Largo.
· Special Needs Residents- Room 626. Room 626 is on the 1 st floor in
the rear building of the school. If you are going North on Usl and
pass the school you will come upon a side street on the RH side. This
is the entrance to the rear of the school and the bus drop off. The first
building you come upon is our building. ***
· Pets - Locker rooms - The locker rooms are located across from the
Gymnasium. If you are standing in the rear of the school facing US 1
the gym is behind you to the left. Walk down the length of the
building and at the end there is a walkway. On the RH side of the
walkway is the entrance to the Locker rooms. **
· General Population - Cafetorium
* Note: See attached pages for maps of each location
** Note: Separate air handlers ensure no cross ventilation. Each location
is large enough to sufficiently shelter the total possible number of pets. In
most cases the clients are very close to their pets and will be able to
access them during sheltering. The only deviation from this is during the
storm.
*** Note: Depending on need each location has various alternative
spaces identified for shelter space, staffing, and other issues.
9
Me Pet-Friendly Special Needs Sheltering Plan
Special Needs "Pet Friendly" Shelter Staffing
Harvey Government Center
2 - County Staff in rotating shifts
2 - Animal Shelter Employees in rotating shifts
1- Kritter Patrol Volunteer
Possible volunteers from animal support organizations
Suearloaf Elementary School
2 - County Staff in rotating shifts
1 - Animal Shelter Employee
1 - Kritter Patrol Volunteer
Possible volunteers from animal support organizations
Switlik Elementarv
2 - County Staff in rotating shifts
1 - Animal Shelter Employee
Possible volunteers from animal support organizations
Coral Shores Hieh School
2 - County Staff in rotating shifts
1 - Animal Shelter Employee
Possible volunteers from animal support organizations
Key Lareo Elementary
2 - County Staff in rotating shifts
2 - Animal Shelter Employees in rotating shifts
Possible volunteers from animal support organizations
10
Me Pet-Friendly Special Needs Sheltering Plan
STANDARD OPERATING PROCEDURE (SOP)
I. LOCA TION
Pet-friendly shelter locations will be those designated by Monroe County Animal Control
Staff as meeting the safety standards for humans and/or animals. Areas for animal
sheltering shall meet the following minimum requirements:
Cats, Dogs, Birds Area
This area should be large enough to separate species and, if necessary, quarantine for
health and safety of animals, owners, and volunteers. Separate areas should be
designated for dogs, cats, and other small animals; Owners will be required to bring
records of recent vaccinations, identification tags or collars, documentation of animal
work status, i.e. seeing eye, disability assistance, NASAR certification, etc.
This area should be easy to clean and disinfect, preferably with concrete, tile or
vinyl flooring that can easily be hosed out, floor drainage is desirable. There should be
access to running water, with available hoses if necessary. Lighting should be adequate
to all areas, indoors and outdoors.
The facility should be large enough to set up a relief and/or exercise area if
outdoor conditions are unfavorable.
FARM I EXOTIC ANIMALS
At this time there are no facilities available for accommodating farm and/or exotic
animals. People who have these types of animals should have their own plans in place
for hurricane season.
II. SET-UP AND SHUT-DOWN
A. Building
Check list to use prior to use of facility:
. Operational water and power
. Adequate lighting
. Ingress and egress through all doors, including emergency exits
. Building security
. Readily available and tagged (within past 12 months) fire
extinguishers
. Operational ventilation
. Location and functionality of restrooms
B. Registration and Intake Area
Located near the animal area entrance, but not a narrow, cramped space.
If co-located with a "people" shelter, have clear directions to pet facility.
All animal areas will be clearly marked with signs.
C. Staff and Volunteer Coordination Area
Will be near the registration area for check-in and checkout, and
coordination of duties.
II
Me Pet-Friendly Special Needs Sheltering Plan
D. Define Animal Areas
NO ANIMAL WILL BE OUTSIDE ITS CONTAINER WITHOUT A
LEASH AND IDENTIFICATION. No animal can be accepted, unless
circumstances become dire, without proof of a valid vaccination for rabies.
Only staff and trained volunteers or animal owners will be allowed to
remove any animal from its container.
1. TRIAGE - This is where animals are tagged, examined, and sent to the
appropriate area. The registration agent will ensure that upon arrival
each owner has equipment, covers, litter boxes, leashes, food and
water bowls, etc., necessary for the care of their pet. Additional
supplies available for use will be provided by the various animal
shelters. All forms will be kept at the registration desks.
2. DOGS - The dog area will probably be the largest, as it will entail
having several smaller areas within it. It is expected that the number
of dogs will outnumber other animals. Alternate housing and care
provisions, which may include a local veterinarian kennel, from a local
veterinarian will be made for dogs for which there is no proof of a
valid vaccination and those animals which appear to be ill, injured, or
too aggressive to handle. Separate areas may be provided for older
dogs sensitive to noise and activity.
3. Animals, which appear ill, injured, or aggressive can be a hazard and
liability. The shelter manager and animal shelter workers will ask the
owner of any animal which may be a hazard to transport to a vet
animal shelter for the duration of the event. It is not within the scope
of our plan to manage ill, injured, or contagious pathogens. An
isolation area will be provided to hold animals until they can be moved
to an alternative location. As circumstances permit, we may assist
with the transportation of these animals.
4. Monroe County retains the authority to refuse admittance to any
animal that appears uncontrollable or too ill for our capabilities or any
animal whose owner is not complying with the minimum standards for
entry.
5. Central to or near the dog area should be an animal relief area. This
may be indoors or outdoors, depending on weather or other conditions.
If outdoors, it is preferable that this be a secure area.
6. CATS - Cats should be housed in a separate area from dogs if
possible. All animals should be in the quietest areas possible. All cats
must be in a covered carrier and come with their own litter box, food,
medicines, etc.
12
Me Pet-Friendly Special Needs Sheltering Plan
7. OTHER SMALL PETS - These include small mammals and birds.
These animals should also be in covered cages away from drafts.
8. FARM ANIMALS AND EXOTIC PETS - At this time owners of
these animals should make their own plans to accommodate their
animals. Monroe County does not have the facilities to take care of
these types of animals.
E. Shut Down
Account for all equipment. Logistically, all equipment should be listed
as it comes into the shelter and accounted for at shutdown. All equipment
will be returned to the agencies or personnel/staff who donated its use
and/or to the client who came in with it.
Clean up. All equipment will be cleaned and disinfected. The facility
will be policed for cleanliness and damage. Floors will be cleaned and
disinfected. All equipment used belonging on the property will be cleaned
and returned to its proper place. The animal shelter staff in each area have
agreed to provide the necessary cleaning and disinfectant supplies.
III. OPERA TIONS
Shelter Kits - There should be several shelter kits available for the fIrst person on
the scene. These kits contain necessary forms and supplies to get things up and
running until other volunteers and equipment arrive.
Registration and forms - Pet-friendly shelter staff will have the owners
complete forms and give owners a copy of the shelter agreement. The registration
forms will notate whether proof of vaccinations is provided for each animal.
Registration forms are to be numbered and those numbers correspond with the
numbers on the cage card. A 4x6 card will be attached to the cage/carrier with
animal's pertinent information. The registration forms will remain at the
registration desk in the file. Animals are then taken to the triage area. Owners
will be given instructions for their pets and procedures and responsibilities
explained to them. When the owner retrieves his/her pets, volunteers will make
sure that all animals and equipment are accounted for. Owners will be required to
sign all entrance and exit paperwork.
The best scenario would allow the clients to care for their own pets. However, at the
initial stages of this plan the clients are being sheltered separately from their animals. As
a result, the pet-friendly shelter staff will be responsible during the time when it is
deemed unsafe for the clients to travel between the people shelter and pet shelter areas.
Visitation - At each of the pet-friendly shelters, Animal Control or Monroe
County staff will have the authority to clear all non-personnel including pet
13
Me Pet-Friendly Special Needs Sheltering Plan
owners from the pet-friendly shelter area before weather conditions become
unsafe to return to the Special Needs shelter.
Feeding - If the pets are housed with their owners, or while it is safe for the
owners to travel between the people shelter and pet shelter areas, the owners are
responsible for feeding and watering their own animals, unless special needs
dictate, in which case volunteers will be assigned to these duties. As it stands, the
animals will be cared for by pet-friendly shelter staff and they will be responsible
for the feedings of the animals during the times it is deemed unsafe for the owners
to be traveling between the two shelter areas. If the animals belong to Special
Medical Needs clients who are not housed at our shelter they will also be cared
for by shelter staff and volunteers either at the pet-friendly shelter or at a location
off site deemed appropriate by Animal Control staff.
Owners shall provide their own food and medicines for their pet(s). Although frequent
visits with pets are encouraged, Monroe County reserves the right to limit visitation to the
pet areas. Preferably no children shall be in the pet area, and the animal care volunteers
will have the authority to restrict the pet areas from children visitation.
Relief-
DOGS - Unless needs dictate, including the unsafe conditions for
travel between shelter areas, owners will be responsible for animal
relief and exercise in designated areas. If numbers of sheltered
pets require, a relief schedule will be devised. The event may prove
such that an indoor relief area will need to be set up. This consists
of plastic sheeting and newspaper.
CATS - The owner shall provide litter and a litter tray (box) and be responsible
for scooping of the litter whenever possible. The pet-friendly shelter staff will be
responsible if the animals are sheltered separate from their owners.
Medication - Unless needs dictate, including the unsafe conditions for travel
between shelter areas, owners are responsible for administering all medications to
pets. The owner shall make sure that any medication necessary should be given
prior to the storm's arrival and as soon as it is safe after the storm. During the
storm the owners will not be able to wander outside their building for safety
reasons. The owner should keep a record of medications administered to their pet
in case a medical emergency occurs.
Sanitation - It is expected of owners to be the primary caretakers of their pet's
cleanliness and sanitation needs. Outdoor relief areas should be cleaned (scooped)
regularly. Indoor relief areas should be changed (newspaper) at least twice daily
Each owner will pick up and dispose of fouled papers and lay down clean papers
for the next dog. This will help prevent spread of disease and reduce noxious
odors. The plastic under the paper will be wiped down a couple of times a day
and the area under the plastic will be disinfected when the shelter closes down.
14
Me Pet-Friendly Special Needs Sheltering Plan
Night staff or volunteers will disinfect floors nightly. Animal care volunteers
shall have the authority to make adjustments to the cleaning routine schedule, as
needed to protect all of the animals in the shelter.
Cages belonging to shelter will be cleaned and disinfected after each use between
animals. Cages and equipment not in use will be returned to the equipment/supply
area.
To provide sanitation and infection control, all staff and volunteers will wash and
disinfect their hands after handling each animal, any cages, containers, cleaning
any relief area, and after any contact with the pets and/or their supplies. As a part
of the closing process, the Animal Control staff will clean and disinfect the "pet-
sheltering" areas and return the building to it's original condition.
IV. EQUIPl\1ENT AND SUPPLIES
Pet supplies to be provided by the owner:
Carriers, cages
Food and water bowls
Leashes, collars, harnesses
Various foods
Plastic sheeting
Sheets and blankets
Muzzles
Flea spray
Cat litter, trays
Towels
Grooming supplies
First aid kit
V. EDUCATION
It is hoped that, as disaster preparedness messages continue to reach the public,
citizens will pre-plan and as such, fewer will need public shelters. Fortunately,
many hotels and motels that do not normally admit pets amend their policies in a
disaster. There are many websites available that have links to pet-friendly
hotel/motels. Registered clients that have pets will be notified by mail regarding
the pet pre-registration requirements. Should pet-friendly sheltering program be
no longer offered, they will be notified so that they may make other arrangements
for their pets.
15
Me Pet-Friendly Special Needs Sheltering Plan
PET FRIENDLY SHELTER LOCATION MAPS
15
~ji
~ ~ I l~
U \ d
~~ ]~~
I. ~ II , 11 0' I .~ ~ .. .11. !~~~ I I~sll.ll \~'[TI
S~(I~nIOVd .\.J.NtlO::) gOHNOW
SNOI.LVAON3H IJ I~ ~I l &'
:l!IJ: 19 I.
l.!- '100H:)S NVWnH.L .~~ :~ J <
I~ l~ A ~ 10
~ i.
a. .~:
~U !~~
~
- "'-~"~
--. .11
. - I :
, - '- . .L I
_ - ,; r i ;-~-, ______u___ ~I T
i ~:: ;:')ir-~-u .-- --t I
I, I I. i
, , I
- , - ----r':
, i i i.i7~! i, ler ~I' . i
1 hSlr;; I i1;; , .,
"-1[f' ---!---- I '1
It- \ -~ ---'t-
': l' n ! -I I
1 _./ I '
......ii- "t" --, :: I '
- ~ ------- ------:::--------}--.-.-~- ~-L-l
1\
II
-- -1d
,~ ',"-lo,~.",-~..".'
. ,__'" ..._......_-J
(:'-",--~\ i ~
\~/I
-~ "-,
(" "
,-y~
.+
~
Z I'
<:
...JI
a. '(
a:-
. 0 b
":\ 0
-~ ...J
\U u.
Q t; b
':\: a:.;.
~ u: ~
~
c:
':S--
j
iii
.
~
J,j ~
. ,Z
i:lb!"1Ii
~r"f
o;gi~
go.u&
~tr...~
"'i~i
ilil~lll
"iJi
. ~~~
!=o "':-.
i!i~
~~ii
i~i~
5i!i
- ~I.~
en !:~i
~ 5;a;
o ~m
Z _"".
. . .
...._,..____..,.,,~_~,,____~.w,.._,..,,_...~,......>.._,"~.,_...".,'_...~~_,'"'_..'.'~_.m'.....__""~.._.'....".__,,._...........,..~. ..........--...
,;"",.< ,.'
>\'':.'
~"~:."'"':\'""'"":'":""m:""'""""":;:"""""'R
"." ' ,"""
;Lk" 'r"" '."..' .'
i'ii.,.v:.,. ,.__..' .
;C>'i ';,~Jr,
.q',~:'/.':':>'''':'
".".:,
I S:ill.LnJ.:Jv.... ..u..Nno.J :ilO\lNOf'(
,~ SNOIJ.Vi\ON3H
If 'OOH::>S NV:WflHJ.
i 1.
dftU
,~ I
~ ~ ,", ~i
H is
~ Il'~
., 0. 1 . 0 'I! '~II",I. I I
~_~~C$cr ~
t l I " ,.'po ,
[~,l~~. ~ i-~-=-' :~ !
, ,:' i .
I 1 ' - I' ----;- - --r----' l; - f
I
I ~
~ (c;) ~
,_li~~,~HT 'Hi"
, I I
l"'-.zr---;'
~c...:.' .'-R' I ;o"'F~ ','
, I II
, II
! \1
! :1
"
':'
&1-+'( .---- -- ."
: !.
i I ;
! : " l'
et-=i=:~.:..:...-=-::-: :~':' - ,::"
': Ii
t
---".-
\\
}:'
......,,~,orllHlt'J.~~P'li....J_k,Wj..~liIfn, J1_1 .' JAlL
l W ,_.... _"'I~- -
i 8 II lil!l! ~!I III [D~ t'II
1~"~ '! "i~l~ ~I~ Ii i.!c'
Ii! ~ .t & ,!; !B
i
"
---" --. -'--'it-
!
---- -----'1"
~-----+,I
I i
i I
, --- ----1--:--
----.11
~I it
-4- '---\-'0-
, i I
: I i
-Q---- ---I'~
I ; i
I ! I
I
~O>. _~~,_
qi
\_/ l
,""
1'-)
'\..:'~
~ I'
oJ.
a. .
,
a:.
o .
o
oJ
u.
s
~
r""
~
'::::::S-
~
-1
~.
Q9
w,-
(/)~
II<
I
III ~
Ii
~1lI~1Ii
o~s~
gluE
, z~!~
R~:
:C~:i
ro~.
~: r'
~~i~
;m
~~il{
i~~i
Hili,"!!
- ~~.~
(/) ~~!.
w ;_;_
I- ~!l!~!l!
o ~m
z _~~.
t. ,t'~Ilo~ltflf,l~ "'f:O~I""""","'k,:-~""""'~
~
:z:
(,)
U)
~
...l
~
::;)
U)
I
]
i
~
~ I IIj
~I
u
I
~~.
wE.iG111 Ebol-\ Wno.,.s..~
~~.." ""'Q./.l,..~
foJc:l (.eooeJ.,","o(. A.n I~'~
I
I
1~ i
rflJ
l!j,
..
1/
S
.~
~
u
o
o
CI
e
:0
lU
o
..J
~
'E
w
e
lU
:0 en
o ~
iii U
::J
()
~ lD
~ ~
~ U
o-tlJ
N E
~ ;r. Q)
, en
U U l!!
~,g
......cn
U ~
o
~
lU
U
en
.8
'0
z
Il
15
co
en
C')
~
~
a
>
~
eN
~o
u"'-
~u
Ii
:I
v
co
C')
~
o
......
u
Ii
Ii
~
W
N
o
......
U
[j
'2
coE
"fio
~~
o
en
U
CI
e
.~
CIl
en
CIl lD
en C')
~ ~
u; u
It)
co
C')
~
EO
.:! C)
... c
o .-
_'0
,!=
III ::s
OIXl
CIlC')
enO
co......
U;U
E
8
'"
gill
CO
0-
ow
E
U Cl ~ ~
C') c: '':;
0 '(ij 0
...... +:
u Ul -
l!:! .!
<( ... 0 ~ lIS
......CIl U
00. c
......- lD CIl ~ V) ~
.::J
ua. 0 CI ~
...... e!
~ U 0 ~ z
en j c ~ ::t:t:
c w
w C C)
c en c
CIl CIl ~
E CI
~ e e!
CIl co .8 ,Q ~
~ 0 m
...... en iii
U w a.
a.
I E ~ I
I
~ !
I- -l_ ~
- W
+- C'\I \I)
lit W ....
- " 0 "- 0
.,. .... ....
"- C') E t ...
...... .~'- c: CO E ll')
0 01 0 U .,. 0 C')
.... '6 0 .... C') 0 r--
Z. -
W 0 0:: .... a: '-
E u; .. & '-
0 ::l
U E
0 ~
0::
E E
I ~
J
I
00 ~
0
.... "- <0 -
.,.
E E- C')
U
0 'l; '- III
0 w
0:: iL ~ \I)
- w
1 :5 "- 0
lit ll') CD
.2 C') 0
'- ....
~ E
0
0
+- I 0::
lit
- I
"- E
:x !
0) ~ ...
0 0 .,. -----l III
.... E <0 -
E 0 C') "-
~
0 '- s: ..,.
0 0 ....
0:: ~ ll') ......
.,.
u C') E
~ '- 0
0 0
A- 0::
E E 1-
1 i
+-
0 lit
~ -
.... C")
.... "- I "- N ......
.,. E- ll') ......
E U .,. I J ~ C')
C') J E
0 . '-
0 "lJ,- 0
0:: CD 0
~ 0::
,
~ C'\I
C') ....
"- ll') ......
C')
~ E '- E
'ij 0
...... "- C') ~ 0
...... .,. 0::
...... s: C')
E u
z. '-
0 ~
0
0::
~
i
Q)
Iii
o
U)
.9
'0
z
o
....
en
c:
~
~
OJ
...
o
o
u::
-
III
...
iL
Cl
c
~
~
G)
z
~
;l
'j
en
>-
G)
'E
S
en
~ ~
i "
'" :
'"
en "'tI .c
0 ~ ClI N
N N ...J 0
E "- '" .. N
S .a
0 ~ 10 e c.. E ~
0 : .., ." 8 III ::I 0 ......
0:: '- ~~ ~ a. I"- 0 c.. 0
~ ~~ 'E E ICl 0:: N
.., :
<E 0 '- E
0 ::I
a.. 0
E 0
~ 0::
"'tI
~
N
0 "-
...... oX
N .!:l
E c..
III U;
0 "'tI
0 f ..,
0:: u.. '-
.
~
"'tI
...... ~
...... N
N "-
E J: 10
0 .!:l <0
0 "ii ..,
0:: f '-
u..
N 'E
...... tt)
N "-
E c.. <0
0 III 10
0 !I ..,
0:: :! '-
"'tI
~
N
M "-
...... 0
N ~
E += 0
III <0
0 Cl ..,
0 Cl. '-
III
0:: CI
I lJ
CI 1
J:
V a..
...... ~
N
E ......
j ..,.
0 ICl
0 ..,
0:: .5 '-
Cl.
Ul
E
o
e
iii
OJ
0::
Ql
n;
E
Ql
U.
Ql
n;
:;:!;
"'tI
c..
tt)
"-
J:
..
~'-
N
~
'E
tt)
"-
III
f.
~
..,
<0
..,
'-
'E
~
E en
f ..,.
t ..,
~ '-
...
III
':;: 10
E ICl
..,
III '-
~
a
>
<0
......
N
E
o
o
0::
1.0
......
N
E
o
o
0::
00
......
N
E
o
o
0::
I"-
......
N
E
o
o
0::
Ul
~
:5
~
III
(.)
CJ'J
.s
o
z
...
o
o
u::
"C
c::
o
(.)
OJ
UJ
en
c::
~
~
OJ
Z
~
~
'j
UJ
>-
OJ
C
.B
UJ
,....JY\ ilrt-l~
,JWf I ((J'-j&
Lll",.._. ..
~Ll'
.....--..
II
"
~
~
~
I .._-,,:~
........R'...
~, '-. .~.
',I:''''.''
I',:
-,:
III
c:
.2
':;j
u
o
....I
~
QI
J:.
u
ClI
ell
...
EICO'" 0 <t co 0> ~ co..,... ."."
000.....000000000
o"7"7"7'9~"'7"O-c-""""""""""",
Q:Nq-.q-C'\I'V"Q"NNVN.q..N
'C
>0 '>
Q)co>,g'ij8 loI"l
g>>-g W ~ ~ Cli~:c{ t = S
-,w.c .uoc: .Q.)<(-")
Qjl<licii~'€~ m<l:~.g...: ",-'i
..c:~ .QJQ .Q.......w CO
<J O'.c -'" it Cll Cll ::J.!: a: ~ Cll E
"" .... .... f"'\ _ .- v ...... ..... ..- _ > ......
'>-.},
''<-r''
~,.<Y~~ I' "
I ~~ff1t~: i ["JI
"J? [,,-el--=l\ ~'7C:-11 ~ j'
---.~~ E "-. ''$-J, I
-1ff:o... -l-:~
I I ".i C , ~ ~ I . !
-I-.j:/ ~=L"
,/~. ' --II "
, u '_ I I"<;:tl' .,
~1Xft,\'j"?,);r~..
i 'I. N'
) H:nx ~.., .. ..,.I......t'f ~ r'"t[;lYIYl;' , .
r.: ',; ! 1;. :('v'~,
I~ ..........'1........ f.'i r I' :
+ _.~t', I
',... 0
"__.]1
j
r
.~
'5l III tI
.. ._ u
~,g;;!E
..~~O
G,) ~ Cb
'fi~3:g..,.
~~~~~
;..i ~ '5 g
:: . Q;C)';
i~""oc.! ;
cQ. ...,..
QlEu=><
.sl'll:~~
,_ U_ ON
EC-6-N
EOGl"O'?
o 15J: ~~
::c:~~CO
.2.!!01ll~
.. ~ -.-
Q.01ll"
O_GIGI
.....Q.lJ:..J:.
...c"'U
- .- l'll
::s ~ Ql
C -
I
I
I
I
; ~ /
II ~~
I I,
". i ~
I.
""'-.----
!:
I'
II
I '
I ~
~'
~'i'
" "'\
, I' C'., ;'"
~,~:"t -j
.~-...---..~\
- . -:'L-::..' \
"__'_ 'r--.-::..."
;
.!!
;j'
.. II
.!Z
ca-
y
-,
Ul
at ..
.. 0
o 0
.c ..:. -
U) V~ L&.
-%
iV.
..
n
..
Ul
...___ L ~_
.-
I.
:i
.
~
~
~1
~ I f:L,
jJ
~
~
E
~
Q~
~S
<
~
~!
~
,
c 00
<~ ~ c;n~ C
=lI'I ~
-8 ;:ElI'I 0
C U
< ~
I ~ I I -=
I tl)1Xl ~ I ,g
~lI'I Cia I~ ro-
lI'I 'R
~
-
u i
lI'I >
= -
lI'I~
~ ..
1C <('C
.,;~lf~
~~9c:l
~
<<
=t::
~
Q
~I
~~
lI'I~<
~:!!~
~ ~
. ClIO
~~
~~ro-
.J~~
<~ '.:I
g
a..
~j
~
~
~
=
~O\
.=$
<
'€
::s
~
CoI
-I-
I::!:;
L
e
x
:i:
;;
u
::II:
~ ~
~ '"
::!!
~ \~ .:i:
.1 "'"
j'-=' <.;>
or,
~ ~I
1
l.g
'"
'S'.l
...
UO\
1:-
J)~
,
I
I
c
.~
=
t
j::lI'I
--
0\0
'"
~
-=
au
::l
:r
J u J~ I ~
ClII 8 Q.:I r
i~
~ 8d~~
II - 'i
._ u
"i-~ c
~~ i
==
E '" /1
8
~ J: ..
.>C - - ~
8 CII'IiP e
= ~lI'I ~
- I
I
I ~
e I 0
I
~ I .., 5
I: < .... u
CII
I ..J "
I--
... ---.". ..tiI.;o-- .
..c -..-". -. -- _. .---
.--- -. .
tl)N ... '-, ....
~lI'I U 1: N :
< l")
u lI'I
OIl
~
CIl
1
I
w
I
I
!
..
u
~
~
~
ro-
=
lI'I
G
1="",_0:
I
;1Xl
:il;l
.::l
~
~
~ ~ g
.i lI'I ~
CoI
tI)
fa >.
It!~8
=<"'C
j ~
~
:;
~ ::3
>cii
1i1i~
Oll'l~
I:
.:
-
\J
::3
~
12\0
Q.,N
I Q:.r,
I u
"Q
I
I
I
~
u
;E
r-
~
1&'1 6
I ~E'" .:
..
~-----
WI
~
e"
Z
Q
..I
5
.
..I
8
~!
tale
..1.51
g:a;,~
iJ~
u
..,
:i
e
Ii I
I l1" .
I'~} I
I:%;~ I
e
li
ilj
=_f"'l
"'" .- \0
,c,t:'
....
on
110
~ ~
It':
-
~ ..,
=!!!Vl
f-~I:.,;
fl8 n Ul
'5 ~
'1 I .::
J:t>.,.,":.::.... II~~
I....>""II.L~_ 11~1Il~1
I ;f j - lilt If II) I I =- ;I: -. I
0 ...
~ :; ~
::.:: ~
.L
- I ~
~i l! '"
.... :; ~ E ~ ~
::.::al ~ .. ::&:~
<
!
~~
~
:Cl
it!'"
.c. c:: g
rot).!!E~
~~V5~
~
... :c
=< .:;
,:N:;
~l:l
N
\C
u
;;
rot) '1: - \C
~o~
I it I
IW)-! ~
---------- _._._---_._---~._~-- -------- -----
I
I~Cl :$
" ~..:l ~ ~
.. ....' -"'oJ Cir'\ ...
,:.!
~
o
'0'
u
~
Q
~-
~1:$
c-
't:
8
c
e
OJ
g
IX
E
'S
III
o
c
o
'" -
]~1
III :..
:I: 1-
Me: u
-1I'l>"C
:l e...
0'"
c:
c:
8
'E
o
~
u
~
o
?:-
:;
:0-
f'll ..,,-
:;:E:
, f ,..., _
--
--. -- -W-.__._~----
If :> c
. -
~ ::;l - .x,
- ... c.r. s: E
g e t:,5- a:
1-5 ~
It'C:
Co;:: ~
"'oJ ......
1&:1
~
~~
l-
c:
,:N
-
~
I
u
'"
::l
o
eX
'E
=
'c'
u
c:l
....
g
S
0
~~ ...:I ~ .
~""'O\ OgN
80: ~a:l;:
u ~
c: = ~
~eo ~ - c:!
::.::.:30: ....
=- 0\
o
e
toG
&>0
c
-
~
~
I! I
...
s
ii t '"
E -.-
'" c:: ~
&i~~
~<
~
8
.!
~~
...:.::
'" c.
-'r::
:I ..
Cl.tn
E
c
u
CD
-
-
c:
,..
I,: _
I ~'5_
ci3"~s
I :l2
u
I~~-
~~o
e
SJ
u]
_ III
~ :c
.~ 1:
9.~
~-
"l:li
c::
N
u
iii
:c
''is
~1
e ,S=-....
'E~ ...
~ 0
e f"'l >.
a:l co
f-
<
~. ~l"" c:
s- :s
Cl. 0 '0
co,:....
U... 0
."
o
'ijj
:i
..----.
II
~
jf~
II:l
"ii
'S
.
~'5
~~
t'
S e
C III
E. ~
"'t:"It-
&5<O::u
---Q---------
E ~
.....:::
~o::~
'"
'C
c:
III
tn
~
b
g
N
I
~
g
N
lfi
::s
-
f
e.
~
=
=
'"
Z
-
Q
.1
-
;>
=
~
~
~
~
~
~
~
t:
III
(3
8
IE
o
.B
l!
1;
'c
'f
~
c:
I-
---r-- -
Me Pet-Friendly Special Needs Sheltering Plan
PET OWNER FORMS
The attached forms are required to be filled out by the owner before the
pet(s) will be admitted into the pet-friendly shelter.
16
MONROE COUNTY
EMERGENCY SHELTER AGREEMENT FOR PETS OF SPECIAL NEEDS CLIENT
I, am registered with Monroe County as a Special
Needs Client. I am the owner of the pet(s) listed on the registration form on the reverse side of this
agreement.
I understand that when an emergency exists for which I have requested to be transported to an
emergency shelter that special arrangements have been made to allow my pet(s) to be sheltered in the
same facility as to that to which I will be transported. I understand and agree to abide by the pet care
rules contained in this agreement. I also understand that Monroe County may terminate this agreement
and withdraw its permission for pets of Special needs Clients in shelters, and that the continuation of the
permission also is contingent upon the approval of the School Board with respect to those shelters
which are schools.
RULES:
1. Only such pets as are identified on the reverse side of this agreement are allowed in the emergency
shelter. It is my responsibility to keep my emergency shelter agreement for pets up to date and to
notify the Monroe County Special Needs Coordinator in writing whenever the pets which I desire to
have covered by this agreement changes.
2. My pet(s) will remain contained in its approved carrier except at scheduled times.
3. I understand that my pets may be kept in a secure location separate from me and that if so
sheltered, they will be attended to by animal care volunteers. If I am sheltered in the same areas of
my pets and can provide care to the pets myself, I agree to the following:
A. During scheduled relief times, my pet(s) will be properly confined with leash, harness or muzzle (if
necessary). Scheduled times will be strictly adhered to.
B. Properly feed, water, and care for my pet(s) as instructed by the shelter manager. I understand all
medication will be controlled by the shelter manager and administration will be properly documented.
C. I agree to properly sanitize the areas used by my pet(s), including proper waste disposal and
disinfecting as instructed by the shelter manager.
D. I will not permit other shelter occupants to handle or approach my pet(s) either while it is in its carrier
or during exercise times. I will make sure the carrier door is latched and secure with a wire or rope tie.
4. I certify that my pet(s) is current on rabies and all other vaccinations required on the reverse side of
this agreement.
5. I will maintain proper identification on my pet(s) and its carrier at all times.
6. I will permit my pet(s) to be examined by qualified animal shelter personnel to determine if medical or
stress conditions requiring attention are present. I further agree to the administration of medication to
alleviate any symptoms.
7. I acknowledge that my failure to follow these rules may result in the removal of my pet(s) to another
location. I further understand that if my pet(s) becomes unruly, aggressive, shows signs of
contagious disease, is infested by parasites (fleas, ticks, lice, etc.) or begins showing signs of stress
related conditions, it may be removed to a more appropriate location. I understand that any decision
concerning the care and welfare of my pet(s) and the shelter population as a whole are within the
sole discretion of the shelter manager, whose decision is final.
8. I further understand that any damage to persons or property caused by my pet(s) will be my
responsibility.
9. I certify that my pet(s) has/have no previous history of aggressive behavior and has not been
diagnosed with any contagious disease for which it has not received successful treatment.
10. I hereby agree and hold harmless all persons, organizations, corporations, or government agencies
involved in the care and sheltering of my animal(s), including injury or loss t%f the pet. I further
agree to indemnify any persons or entities which may suffer any loss or damage as a result of the
care and sheltering of my animal(s).
11. I will sign for any items loaned to me to provide proper care of my pet(s) during an emergency.
SIGNED
PRINTED NAME
DATE
MONROE COUNTY
SPECIAL NEEDS CLIENT
PUBLIC EVACUATION SHELTER PET REGISTRATION AND AGREEMENT
Owner:
Address:
City: I FL TZiP:
Phone: I Email:
ALL ANIMALS ARE REQUIRED TO BE IN CAGES OR CARRIERS. (Please mark
cage/carrier with owner's identification)
EMERGENCY CONTACT (NOT IN SHELTER)
(Name)
(Phone)
Licensed Animals (Dogs, Cats, Ferrets) - Limit of 4 Total
Type (Dog,
Name Cat, Ferret) Breed/Color/Other 10 Mark License # Vaccinations.
Birds
Name
Breed/Color/Other 10 Mark
Vaccinations.
ARE ANY ANIMALS ON MEDICATION? If so explain and give time normally administered:
Can medication/ supplements be given in regular food rations? _yes_no
Are there medical problems or behavioral characteristics we should know about? If yes, list:
(This information is required only for purposes of planning & not to affect the acceptance of the pet at the shelter.)
.Vaccinations: At the time of registration, County staff shall insert the Rabies Vaccination tag # and list
the required vaccinations for which pet has documented proof. A predetermined list of vaccinations for
specific types of pet shall be used to determine the vaccinations which are required.
...................................................................................
Vaccinations current for:
Through (date)
County staff Signature:
Date:
I Pets Released to Owner
Me Pet-Friendly Special Needs Sheltering Plan
VOLUNTEER FORMS
The attached forms are required to be filled out by all volunteers before
they can assist in the shelter in any way.
17
OKI!~ErY ~o~~~~E
(305) 294-4641
("- ,-....-
BOARD OF COUNTY COMMISSIONERS
Mayor Murray E. Nelson, District 5
Mayor Pro Tern David P. Rice, District
4
Dixie M. Spehar, District 1
George Neugent, District 2
Charles "Sonny" McCoy, District 3
Monroe County Human Resources
1100 Simonton Street, #268
Key West, FL 33040
(305) 292-4557 - Phone
(305) 292-4564 - Fax
MONROE COUNTY VOLUNTEER APPLICATION FORM
PERSONAL INFORMATION:
NAME:
HOME PHONE:
SS#
ADDRESS/CITY/ST ATE/ZIP:
VOLUNTEER INFORMATION:
VOLUNTEER ASSIGNMENT: (FACILITY 1 LOCATION)
TIME AVAILABLE:
ANY ACCOMODA TIONS NEEDED IN ARRANGING YOUR ASSIGNMENT?
TRANSPORTATION:
WILL YOU BE DRIVING AS PART OF YOUR VOLUNTEER ASSIGNMENT? YES () NO ( )
DO YOU HAVE TRANSPORTATION: YES () NO()
CAR INSURANCE COMPANY:
DRIVER'S LICENSE#:
POLICY #
EMERGENCY CONTACT:
NAME:
RELATIONSHIP:
ADDRESS/CITY/ST A TE/ZIP:
HOME PHONE:
VOLUNTEER STATUS AGREEMENT
I
, VOLUNTEER MY SERVICES THROUGH
(Print Name)
, AND UNDERSTAND THAT I AM NOT AN
(Agency or Department)
EMPLOYEE OF THE MONROE COUNTY BOARD OF COUNTY COMMISSIONERS.
(Signature of volunteer)
(Signature of witness)
(Date)
(Date)
VOLUNTEER INSURANCE AGREEMENT
I , THE VOLUNTEER, UNDERSTAND THAT IF I USE MY PERSONAL
AUTO IN MY VOLUNTEER SERVICE, I WILL ARRANGE TO KEEP IN EFFECT AUTOMOBILE INSURANCE
EQUAL TO THE MINIMUM LIMITS REQUIRED BY THE STATE OF FLORIDA. I ALSO UNDERSTAND THAT
ANY ACCIDENT MEDICAL COVERAGE SUPPLIED TO ME WILL BE IN EXCESS OF ANY AVAILABLE
MEDICARE OR GROUP HEALTH INSURANCE PROGRAM IN FORCE:
(Signature of volunteer)
I DESIGNATE
ACCIDDENT AL DEATH BENEFITS AVAILABLE TO ME.
AS MY BENEFICIARY FOR ANY
RELATIONSHIP TO BENEFICIARY:
PHONE:
ADDRESS/CITY /ST A TElZIP:
VOLUNTEER DRUG-FREE WORKPLACE AGREEMENT
VOLUNTEERS MAYBE SUBJECT TO BACKGROUND CHECKS. MONROE COUNTY IS A DRUG-FREE
WORKPLACE AND VOLUNTEERS ARE SUBJECT TO THE MONROE COUNTY DRUG-FREE WORKPLACE
POLICY AND WORK RULES.
(Volunteer Signature/Date)
VOLUNTEER LIABILITY WAIVER AGREEMENT
I understand that I am volunteering my services, that I am responsible for my own actions and hereby
waive any liability for any injury to myself or any of my property which I may have at the volunteer
site. I further covenant and agree to indemnify and hold harmless Monroe County Board of County
Commissioners from any and all claims for bodily injury (including death), personal injury, and
property damage (including property owned by Monroe County) and any other losses, damages, and
expenses (including attorney's fees) which arise out of, in connection with, or by reason of the above-
referenced volunteer activity.
(Volunteer Signature/Date)
DISASTER RESPONSE VOLUNTEER INTAKE FORM
Please Print
AGE (IF UNDER 18)
NAME
EVENING
OTHER
PHONE.-DAY (AREA CODE INCLUDED)
ADDRESS
CITY
STATE
ZIP
SKILLS
C Veterinary Medicine
C Small Animal Handling
Ii Exotics and Wildlife Handling
L::J Computer
C Other
C Animal Sheltering
C Farm Animal Handling
[] AdministrationIManagement
[] Customer Service
C Animal Rescue
C Equine Handling
[] Communications
WILLING TO DO
IJ Animal Care
C Animal Health Care
11 Date'1 Entry
Lj Other
[] Animal ReSClle
C Office Work
[] Driving
[] Shelter Clean-Up
C Phones
[] Damage Assessment
VACCINATION HISTORY
[j Rabies Pre-Exposure, Date
Ii Tetanus, Date
[] Hepatitis A, Date
WHEN AVAILABLE MON TUE WED THU FRI SAT SUN
Morning
Afternoon
Evening
LENGTH OF TIME AVAILABLE (1 WEEK, 1 MONTH, OPEN)
STARTING DATE AVAILABLE
IN WHAT PART OF THE COUNTY ARE YOU WILLING TO WORK?
SPECIAL EQUIPMENT! RESOURCES OFFERED
REFERRED BY
COMMENTS
INTERVIEWER
DATE
THE HUMANE SOCIETY OF THE UNITED STATES . DISASTER SERVICES
5
ANIMAL RELIEF VOLUNTEER BADGE
Volunteers should haue name tags. Use the {ollowing as a master, typing in the name ofyollr sheller above
the first line on each badge. then photocopying the master. Use heavy stock. You can llse different color stock
so that the type ofuolllnteer is readily identified by the color.
ANIMAL RELIEF VOLUNTEER
__________________________________________________T___-----------------------------------------------
ANIMAL RELIEF VOLUNTEER
--------------------------------------------------+--------------------------------------------------
I
,
I
I
I
I
I
I
I
I
NAME OF VOLUNTEER
NAME OF SHELTER
Issued By
Date
Identilh"GtlOII valid only whcn pres(;ntcd with a picture ID.
ANIMAL RELIEF VOLUNTEER
NAME OF VOLUNTEER
NAME OF SHELTER
Issued By
Date
ldt'nti/ication Fo/iel on'-v when j)rr:.>;ented with a picture IV.
NAME OF VOLUNTEER
NAME OF SHELlER
Issued By
Date
Identification ['alid Old..... whcn prL'~t>ntcd with a pic:tllrl' lD.
ANIMAL RELIEF VOLUNTEER
NAME OF VOl.UNTEER
NAME OF SHELTER
Issued By
Date
IdentificatIon valid only 1I,/1.('n plY'.<umted wzth lZ pictulY: IV.
--------------------------------------------______1__-_______________________________________________
ANIMAL RELIEF VOLUNTEER
ANIMAL RELIEF VOLUNTEER
NAME OF VOLUNTEER
NAME OF SHELTER
Issued By
Date
__________________________________________________T___-----------------------------------------------
ANIMAL RELIEF VOLUNTEER
ltif:nti/i,,'u.fu,Hl r;a]u[ only /(Ih...n prn:enkd !.;i/h a pU'/lJN: In.
ANIMAL RELIEF VOLUNTEER
NAME OF VOLUNTEER
NAME OF SHELTER
Issued By
Date
JdclttljicatuJIllpalid mtl\' !..ch,('fI pfl;~t'ntty' inth u picture llJ.
Idl!ntr{rcGtion l'(llld only wht:1l prl'W'nfcd i.l.'ith a pic/u.n! If).
NAME OF VOLUNTEER
NAME OF SHEl.TER
Issued By
Date
!daliifh'(JliilfJ l'(llid (Jnly l;;JW11rm>St:1I1I.'d lJ:ilh (J piduro> lJJ.
NAME OF VOLUNTEER
NAME OF SHELTER
Issued By
Date
THE HUMANE SOCIETY OF THE UNITED STATES . DISASTER SERVICES
6