First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
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Email*

Home Phone

Work Phone
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Cell Phone*

Make, model, color, and year of Car using for transport (if using multiple cars, please list all)*

Please tell us a name and phone number of your emergency contact:*

How did you hear about Little Paws Dachshund Rescue? *

I attest that I understand the risks present in volunteer duties, particularly in working with animals, and freely assume those risks and agree to release and indemnify Little Paws Dachshund Rescue, its officers, agents, employees and volunteers from and against all claims for injury, accident, loss or danger to the undersigned as a result of such volunteer duties.