Transport Application & Release of Liability Please download the Transportation Application and e-mail it to SNARR Transport You may also complete the online form below. Transport Application & Release of Liability Name* First Last Email* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Home PhoneCell Phone*Please provide your vehicle information that will be used for transport.*You may enter more than one vehicle.YearMakeModel Name of Employer Company Name Employer Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Please Answer the Following QuestionsDo you have a valid driver's license?* Yes No In case of an emergency, please specify a person whom we should contact.You may enter more than one contact.NameRelationship to YouPhoneEmailPhysical Address Do you have allergic reactions to specific animals?* Yes No If yes, please describe your allergies.Do you have a medical condition we should be aware of?* Yes No If Yes, please describe the medical conditions.Please list any organizations that you are or have been actively involved in.Please enter Organization Name, Contact Name, and Contact Phone or Email. Thank you!Organization NameContact NameEmail or Phone Please list days, times and areas where you are available for transport.*Terms & Conditions1. I certify that all information provided on this application is true and complete to the best of my knowledge. Any misrepresentation or omissions of facts called for in the application may result in a denial of a volunteer opportunity or dismissal from SNARR. 2. I understand that if I am selected , I am a volunteer for and devoting my time to SNARR on a voluntary basis and I am serving with no contemplation of compensation for my services. 3. I give SNARR my permission to investigate all pertinent information and references concerning my volunteer application. And, I release SNARR from all liability for any damage, both legal and otherwise, for issuing this information. 4. I hereby release SNARR, from all losses, damages and claims of any kind arising out of my own negligence or misconduct. SignatureDate MM slash DD slash YYYY SNARR VOLUNTEER RELEASE OF LIABILITY AND WAIVER1. I understand that because I may handle and/or come in contact with animals, it is important to discuss being vaccinated against tetanus with my physician. I release SNARR Special needs animal rescue & rehabilitation from all responsibility that may occur because of my not pursuing this matter further and I understand whatever decision I make is at my own risk. I have read, understand and agree to the above tetanus information. 2. I acknowledge and understand that as a volunteer of the SNARR Special needs animal rescue & rehabilitation, I am not covered by workers’ compensation or any other insurance policy for any damages or injuries I may sustain during volunteer activities. I understand that I am responsible for obtaining health insurance coverage through an independent health insurance company. 3. I fully understand that as a part of my volunteer work for SNARR Special needs animal rescue & rehabilitation I will come into contact with animals by directly handling them, fostering 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. 4. I fully understand that as a volunteer and/or foster home for SNARR Special needs animal rescue & rehabilitation my family may come in contact with animals at events, and I and my family and/or guests may come into contact with animals in my home if I am fostering an animal. I understand that working with animals carries a risk of injury, and it is possible that my family and/or guests may be bitten, scratched and/or otherwise injured. 5. My signature to this volunteer liability release attests to my intent to hold harmless and release from all liability SNARR Special needs animal rescue & rehabilitation or any of its past, present or future 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. Printed Name SNARR Volunteer* Signature of SNARR Volunteer*Date* MM slash DD slash YYYY CAPTCHA Δ
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