HPR OPERATION PAW LIFT

1
Date
Date
Year
Month
Day
2
Name* This field is required.
First Name
Last Name
3
Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
4
Phone Number* This field is required.
Area Code
Phone Number
5
Mobile Phone NumberIf mobile is the same above leave blank.
Area Code
Phone Number
6
Email
example@example.com
7
Certification
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
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8
Type of Aircraft And Capacity
Huge
Large
Normal
Small
Ok
Ok
9
Image FieldUpload Aircraft Picture.
10
Your Pilot's License
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
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11
Upload Liability Insurance Declaration Page.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
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12
Current Medical.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
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13
Is This a Company Plane
YESNO
14
If The Above Answer Is Yes.Company Name, address and telephone number.
15
How Can You Best Assist
Transporting animals
Transporting supplies
Transporting, animals and supplies.
Transporting animals and supplies.
Assist with First Responder Deployment only.
Assist with all of the above.
Assist with all or one of the above, plus search and rescue on the ground.
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Liability waiver.* This field is required.This is a legal document. By signing this document you are agreeing to its terms.
I have voluntarily applied to assist Hurricane Pets Rescue Inc. (HPR) with the work referenced in the Position Description(s) for my volunteer role(s), and as specified in the Volunteer Agreement I signed.By applying for and performing this volunteer work, I agree as follows and have initialed each item to indicate that agreement:___ I am aware that this is a contract between me and HPR and that it waives legal rights that I may have now or in the future and releases HPR and others from claims for damages.___ I AM VOLUNTARILY PARTICIPATING IN THIS ACTIVITY WITH FULL KNOWLEDGE OF THE TASKS INVOLVED. __ I AGREE TO ACCEPT ANY AND ALL RISKS ASSOCIATED WITH MY PARTICIPATION, INCLUDING BUT NOT LIMITED TO INJURY, ILLNESS AND DEATH.___ I understand there are risks and dangers associated with working with feral and domesticated animals, including but not limited to, bites, scratches, zoonotic diseases (diseases transmitted from animals to humans), and allergic reactions. I also understand there may be risks involved with exposure to certain chemical cleaning products while performing my volunteer duties. I fully understand and accept those risks and dangers.___ I fully assume all the risks involved with my volunteer activities, and acknowledge that they are acceptable to me. I agree to use my best judgment in undertaking these activities. I also agree to follow the rules and safety instructions as given by HPR directors and volunteers authorized to act in a supervisory capacity.___ I agree that I will not sue, prosecute, or in any way make a claim against HPR for injury to me or damage to my property resulting from the negligence or other acts, howsoever caused, by volunteers of HPR or other people as a result of my volunteer duties.___ I fully and forever release and discharge HPR from any and all actions, causes of action, claims,liabilities, or demands I have or may have in the future, whether known or unknown, for injury, illness, death or damage arising out of or related in any way to my volunteer duties.___ I agree that HPR may use my name, and pictures, photographs, or video and/or sound recordings of me on television, on radio, on the Internet, in emails, and in stories, news articles, advertisements, or other written or digital materials. I agree that such uses may include education, advocacy, and fundraising.___ I consent to and authorize, in advance, such use and agree that HPR does not have to notify me of such use or provide me with other consideration for such use. I waive any rights of privacy and/or publicity I may have in connection with these uses.___ I agree that the rights I am giving up and agreements I am making apply equally to me and to my heirs, successors, assigns, guardians and legal representatives. I agree that none of those individuals may make any claim or take any action that I could not make or take myself.___ I agree that this Waiver and Release of Liability protects and is for the benefit of Hurricane Pets Rescue and also for its affiliates, and their respective employees, officers, directors, consultants, interns, volunteers, licensees, and all others acting on their behalf. I also agree that I may not make any claim or take any action against any of those affiliates or individuals that I could not make or take against HPR itself.___ I intend to fully and voluntarily waive any rights I have as described in this Waiver and Release of Liability.To the extent that legal consideration is required for this Waiver and Release of Liability to be effective, I agree thatI have received good, valuable and sufficient consideration by being permitted HPR to provide volunteer service and to receive training and instruction.I HAVE CAREFULLY READ THIS WAIVER AND RELEASE AND FULLY UNDERSTAND ITS CONTENTS AND ACCEPT AND SIGN IT OF MY OWN FREE WILL. If I am under 18 years of age at the time of registration, my parent or legal guardian has completely reviewed this Waiver and Release of Liability, understands and consents to its terms, and authorizes my participation.
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Place your digital signature here.* This field is required.Your digital signatures serves as your actual signature for the purpose of the liability waiver in the prior field.
18
Image FieldPlease upload a picture of yourself.
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Please verify that you are human* This field is required.
Should be Empty: