First Name*

Last Name*

Address

City

State/Province

Zip/Postal Code
 - 

Email*

Home Phone

Work Phone
x

Cell Phone*

What city/town do are you currently in? Provide zip code as well.*

Which shelters are you willing to drive to to pick up a dog and deliver them to Spring?

What is Your Driver's License number? Issued by which state?*

What kind of vehicle do you drive?*

Do you have an record of DUI/DWI, reckless driving or other dangerous driving offenses?*

Do you have auto-insurance? *

Do you agree to provide a safe, humane and secure transport for every animal entrusted to your care. You agree to be fully responsible for the safety and well being of the pet and will provide a safe, loving, humane environment with adequate food water and shelter at all times while the animal is in your care.*

All the pets in the Yorkie Rescue Houston program are the property of Yorkie Rescue Houston and must be returned within 24 hours of request. I agree that I am transporting this pet for Yorkie Rescue Houston and that I do not have any right of ownership over any transport animal. I further agree that Yorkie Rescue Houston’s rights in and to my transport pet are superior to mine. Animals cannot be transferred to the custody of another person, shelter, humane society, SPCA, or other entity without prior consent and permission of Yorkie Rescue Houston. I agree to surrender this pet to an authorized YRH representative upon request/demand.*

I agree that accidental animal bites or other injuries to humans and other animals do occur, and agree to hold harmless and indemnify, and protect Yorkie Rescue Houston from any claim or suit filed by someone as a result of such incident. In addition, Yorkie Rescue Houston will not be responsible if animal should damage or destroy property belonging to transporter, transporters household, or others, or if the animal shall transfer any disease, internal or external parasites to other animals and people in transporters household.

I understand that if I am approved for transport, this declaration represents a legal contract between me as the transporter and Yorkie Rescue Houston. I understand that I must abide by this agreement and that this agreement applies to any and all animals that I transport for Yorkie Rescue Houston!*

By entering my name, I hereby swear or affirm that I have answered the previous questions truthfully to the best of my ability and knowledge.*