Liability Release Form

Name *
Name
Address *
Address
Phone *
Phone
Emergency Contact *
Emergency Contact
Emergency Contact Phone Number *
Emergency Contact Phone Number
If you have none, put N/A.
As a Heartland Small Animal Rescue Volunteer, I agree to: *
By typing your name in this field, you acknowledge the statements above.
If you are under 18 years old, please have your parent/guardian type their name into the field below as acknowledgement of this agreement.