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PET SHELTER REGISTRATION AND AGREEMENT <br />I, the animal owner signed below, request the emergency housing of the animal being evacuated because of a pending or <br />occurring disaster. I must be housed at this shelter during my pets stay. The animal owner hereby releases the <br />person or entity who is receiving the animal from any and all liability regarding the care and housing of the animal during <br />and following this emergency. The animal owner acknowledges that if emergency conditions pose a threat to the safety of <br />the animal, additional relocation may be necessary, and this release is intended to extend to such relocation. <br />The animal owner acknowledges that the risk of injury or death to the animal during an emergency cannot be eliminated <br />and agree to be responsible for any veterinary expenses which may be incurred in the treatment of their animal. It is also <br />required that the owner or his /her agent take responsibility for the care, feeding and maintenance of their animal. Check <br />out is required when departing from the shelter. <br />Animal Owner Signature <br />Date <br />Animal Owner <br />Name <br />Address <br />City <br />Cell Phone <br />State <br />Emergency Contact Name (not in shelter) <br />Emergency Contact Person in <br />Zip Home Ph <br />Do you have your phone available now? _ <br />Phone <br />Shelter <br />(This person would provide care for your pets in the event an emergency would occur) <br />Name of person in charge of animals care (must be staying in the shelter): <br />Name of animal <br />Color Sex Breed Age <br />(Only animals crated together on one sheet) <br />Are your pets on any medication? <br />Cabarrus County EOP — Annex L — Shelter and Mass Care <br />Attachment number 12 <br />F -6 Page 291 <br />