Transport Application
Complete this form if you would like to volunteer to assist in transporting.
Required Fields marked with *)
Please provide the following information about yourself
:
*
Your Name:
*
Street Address
*
City, State & Zip
*
Home Phone
Work Phone
(Include Area Code)
*
Mobile Phone
(Include Area Code)
*
Email
Please provide the following information
:
License Plate Number
Car Make and Model
Do you have car insurance?
Yes
No
Company Name
How many Great Danes can you transport at one time?
How many miles or how long of a drive are you able to transport?
Veterinarian Information (if you do not have a vet, please enter a reference) Name:
Street Address
City, State & Zip
Office Phone
Have you or anyone in your household ever been convicted of animal cruelty, neglect, dog fighting, or other animal-related crime?
Yes
No
I, the undersigned, agree to provide proper care for any animal in my possession, temporary or permanent. I understand that Dane T.R.A.I.N., Inc. does not carry liability insurance for my home or vehicle, and I agree to hold the Dane T.R.A.I.N. harmless for any damages caused by myself or others, the animal, to or by my vehicle while I am caring for an animal for Dane T.R.A.I.N. I also agree to carry liability insurance on my automobile. I understand that I am a volunteer and not an employee of Dane T.R.A.I.N., Inc. By submitting this form, Dane T.R.A.I.N. has my consent to verify my car insurance policy and contact my veterinarian. I realize that this/these dogs have not been totally evaluated as to
temperament
and relieve Dane T.R.A.I.N. of liability.
By checking this box, you agree to the above.
Created by Laura Beck.
Copyright © 2003, 2004, 2005 Dane Train Network, Inc. All rights reserved.
Revised: January 15, 2005
