Mid-Atlantic Chinese Shar-Pei Rescue Operation, Inc.

VOLUNTEER AGREEMENT AND RELEASE


Instructions: Print this form, complete the information requested and mail to:

Mid-Atlantic Chinese Shar-Pei Rescue Operation, Inc.
P.O. Box 34034
Bethesda, MD 20827
or fax to (301) 770-2731



I, ________________________________________, as a volunteer service provider to the Mid-Atlantic Chinese Shar-Pei Rescue Operation, Inc., hereby declare that I shall not hold the Mid-Atlantic Chinese Shar-Pei Rescue Operation, Inc. liable for any illness, injury, or disease I might contract or sustain while working in said capacity.

The Mid-Atlantic Chinese Shar-Pei Rescue Operation, Inc. makes no representations concerning any animal's exposure to rabies or other diseases.

Furthermore, I will comply with all of the regulations, policies, procedures, and ethics of the Mid-Atlantic Chinese Shar-Pei Rescue Operation, Inc.

I understand that my failure to do so will result in my termination as a volunteer.

Volunteer Signature: _________________________________ Date: _____________________

Volunteer Address:  ___________________________________________________________

Volunteer City/State/Zip:  _______________________________________________________

Volunteer Phone:  Home:  _____________________________ Work:  ____________________

Volunteer email:   _____________________________________________________________

 Parent/Guardian: ___________________________________ Date: _____________________

 Witness: _________________________________________ Date: ____________________


Co-Chairperson 
Joyce Hanes
(301) 881-1221
Fax: (301) 770-2731		 Web Administrator
Debra Pope
(703) 330-3694

THE MID-ATLANTIC CHINESE SHAR-PEI RESCUE OPERATION, INC.