A. Personal Information

Name ___________________________________________________________
Address______________________________City_______________State______Zip_______
Phone Number___________________ Alt. Phone (cell or pager)________________
E-Mail Address ____________________________________________________

B. Liability Waiver

I, _________________________________, certify that the information provided on this form is true and correct. I understand that as a volunteer for NERR&R I provide my own automobile and health insurance, and hereby agree to not hold NERR&R, Inc. or any of its volunteers, associates or foster care providers liable for any physical, emotional or property damages that are a direct or indirect result of activities involved in the placement, transport, grooming, training or evaluating of Rottweilers in any way associated with NERR&R. This includes any and all activities I perform as a NERR&R volunteer.

I have read NERR&R's policies and code of conduct____(init) and agree to act in accordance with them while I am representing NERR&R. I understand the volunteer coordinator will notify me once I have been approved.

I understand NERR&R’s Get Active campaign requires that I perform a minimum of two activities related to the rescue group during the calendar year.

___________________________________
Signature/Date

After signing and initialing this document, please mail to:

North East Rottweiler Rescue & Referral Inc
PO Box 6456
Portland, ME 04102