Medical Information: In case of emergency, I authorize The Rescue House to notify the contacts listed below. Personal/Professional emergency contacts (2) (include Name, telephone number, and relationship to you)

1._____________________________________________________________________________

2._____________________________________________________________________________

RELEASE OF LIABILITY:

I fully understand that as a part of my volunteer work for The Rescue House I will come into contact with animals either by directly handling them, or through assisting in their care and adoption. Further, I understand that working with animals carries a risk of injury, and that it is possible that I may be bitten, scratched, and/or otherwise injured. My signature to this volunteer liability release attests to my intent to hold harmless and release from all liability The Rescue House or any of its Officers, agents, volunteers, employees or assigns, from all acts which are related to the normal performance of required and implied duties. My Signature, whether original, by fax or any other electronic means, is valid as if it were an original signature

Signature __________________________________________________   Date _____________

Print Name ________________________________________________