Name *

Name

First Name

Last Name

Address *

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number *

Phone Number

(###)

###

####

Cell Phone

Cell Phone

(###)

###

####

Work Phone

Work Phone

(###)

###

####

Signature *

Signature

I am aware that by signing this application, I agree to provide what is needed for the health and safety of a dog fostered in my care for Multiple Breed Rescue. I further agree to assume all responsibility for the foster dog in my care while on or off the premises. I agree to assume all liability for the dog while I foster it for the Multiple Breed Rescue. I fully understand and agree to assume all risks involved in any and all duties that I perform for Multiple Breed Rescue in my volunteer capacity and I agree to hold Multiple Breed Rescue harmless for any injury(s) that I might sustain during the course of my volunteer duties. I agree to not sell, rehome or surrender the dog I am fostering for Multiple Breed Rescue for any reason. I understand that an authorized agent of Multiple Breed Rescue will handle the placement of the dog and should I need to have the dog removed from my home I will contact Multiple Breed Rescue immediately. This waiver does include myself, all of my family members and descendants forever from seeking any legal action whatsoever against Multiple Breed Rescue or its’ representatives.

First Name

Last Name

Date *

Date

MM

DD

YYYY