RELEASE

hereby request the emergency quartering of these animals being evacuated because of a pending or occurring disaster. The animal owners (agents) hereby release the receiving property owners and any caregivers from any and all liability regarding the care and quartering of these animals during and following this emergency. The animal owners (agents) acknowledge that if emergency conditions pose a threat to the safety of these animals, additional relocation may be necessary and that this release is intended to extend to such relocation.

The animal owners (agents) acknowledge that the risk of injury or death to these animals during an emergency can not be eliminated and agree to be responsible for any veterinary expenses which may be incurred in the treatment of their animals. It is also requested that the animal owners (agents) contribute to the feeding and daily care of their animals, if possible.

The cost (if any) of returning these animals after the emergency will be at the owners= (agents=) expense. If an animal is not claimed within thirty (30) days, unless prior arrangements have been made, the animal owner will be notified of possible adoption or relocation.

It is the responsibility of the animal owner (agent) to keep the receiving property owners aware of
where the animal owner (agent) can be contacted following the emergency.

Address to which Owner (Agent) plans to evacuate during the emergency	____________________________________________ ____________________________________________
	Phone_______________________________________