Volunteer Releases And Waiver Of Liability - Lone Oak Rescue Page 3

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I acknowledge that I have carefully read this
agreement and
Release of Liability and know
and understand its contents
without question, and voluntarily sign my name evidencing
my acceptance of the above provisions.
X___________________________
X_________________________________
Lone Oak Representative Signature
Participant Signature
DATE________________
DATE_________________
NAME: ___________________________
CDL# _______________________
ADDRESS: ____________________________________________________________
____________________________________________________________
CITY, STATE & ZIP: _____________________________________________________
PHONE (
) _____ - __________
CELL
(
) ______ - ___________
EMERGENCEY CONTACT:
NAME: ___________________________ PHONE (
) _____ - __________
MINORS DO NOT SIGN THIS FORM-- PARENT OR LEGAL GUARDIAN MUST COMPLETE
THIS SECTION
I, the undersigned parent or guardian of the above participant, in consideration of my minor’s
participation in any activities, agree that the terms and conditions of this Release of Liability shall
be binding as to damage or injury to my minor, his animals, and property arising out of his
participation in events.
I acknowledge that I have read this Release of Liability and know and understand its
contents.
X___________________________
X_________________________________
Lone Oak Representative Signature
Parent or Guardian Signature
DATE_____________
DATE _________________
NAME: ___________________________
CDL# _______________________
ADDRESS: ____________________________________________________________
____________________________________________________________
CITY, STATE & ZIP: _____________________________________________________
PHONE (
) _____ - __________
CELL (
) ______ - ___________
Page 3 of 3
Lone Oak Rescue Inc is a registered 501(c)3 non-profit organization. Tax ID#27-0349821

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