RELEASE FORM

This general release is used by an individual (The “Releasor”) to release all claims against another individual or company (the “Releasee”).  The signatures on this form relinquish all claims between these two parties.

I, (name of releasor) _____________________________________, residing at (address)

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Relinquish all claims, or future claims, against Pickens Animal Rescue, Inc., (releasee) of 401 Old Whitestone Road, Talking Rock, GA  30175.

It is my understanding that when I work with animals or in an environment where animals are present, there is always a risk of injury or illness.  I am voluntarily helping with the animals and in no way will hold Pickens Animal Rescue, Inc. responsible for any injury or sickness. I will use every precaution to avoid any such injury or illness to myself or other individuals while I’m volunteering at the Rescue Ranch or any activity involving Pickens Animal Rescue, Inc.

_______________________              __________________            __________________

Signature of Releasor                          Date                                         Phone #

_______________________              __________________            __________________

Signature of Releasee                          Date                                         Phone #

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Signature of Witness

Pickens Animal Rescue, Inc. PO Box 45, Jasper, GA 30143 706-692-2772