First Name*

Last Name*

Address

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Email*

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Drivers License #:*

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What days/hours are you available?*

What companion animals do you currently care for?*

Please list any experience that you have that would be an asset to our rescue:*

What are your areas of expertise/interest?

Do you understand that animals may be unpredictable and that Bully Rescue & Advocacy Group, Inc. cannot guarantee that an animal we have rescued or attempting to rescue will not be temperamental? YES or NO

In consideration of my participation as a volunteer for Bully Rescue & Advocacy Group, Inc., I do hereby release and forever discharge Bully Rescue & Advocacy Group, Inc., its affiliates, directors, officers, agents, other volunteers and employees from any and all claims, demands and causes of action which the undersigned now has or which the undersigned or the undersigned’s heirs, executors, administrators, assigns or successors may have by reason of any activity in connection with volunteer activities and visits. I agree to hold harmless and indemnify Bully Rescue & Advocacy Group, Inc., its affiliates, directors, officers, agents and their heirs, executors, administrators and assigns, of and from all of the liabilities described above, arising out of or connected with the volunteer activities of said organization. I have never been convicted of animal cruelty, neglect, or abandonment, pursuant to VA Code & 3.1-796.96:5 (B) and (C).

Applicant’s Signature and Date Signed: *

BRAG Representative Signature and Date Signed: *