HEET Incident Volunteer Form
Incident Name:
*
Date:
*
-
Month
-
Day
Year
Date
Name
*
First Name
Last Name
Email
example@example.com
Drivers License#
*
Class
*
State
*
Street Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
City:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
State:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Zip Code:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Phone#:
Format: (000) 000-0000.
Cell Phone#:
*
Format: (000) 000-0000.
Truck Make & Model:
*
Truck State & License#:
*
Trailer Make & Model:
*
Trailer State & License#:
*
I,
*
Enter Full Name
(VOLUNTEER) acknowledge that I am volunteering my services to the Horse Emergency Evacuation Team(HEET). I acknowledge that I am aware that handling horses is a hazardous activity, and that I could be seriously injured or even killed during such activities. I also acknowledge that HEET activities may occur under dangerous circumstances, such as wildfire or vehicle accidents, which could result in my injury or death.
I am over the age of 18.
*
Enter intials
Liability Release Statement
This statement serves as an acknowledgment by the applicant releasing the Horse Emergency Evacuation Team (HEET) from any liability for injuries or damages sustained during participation in HEET activities, rescues, or functions. The applicant confirms agreement by providing their full name, signature, and date below.
Release of Liability Acknowledgment
I hereby release HEET from any liability for injuries or damage sustained by my participation in HEET activities, rescues or functions. The signer intends the waiver and release to be binding on their heirs, assigns, and successors in interest.
Applicant Full Name
*
First Name
Last Name
Date of Agreement
*
-
Month
-
Day
Year
Date
Applicant Signature
*
Acknowledged & Verified by HEET Member:
Members Type in Full Name
Continue
Continue
Should be Empty: