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Name

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

for Picture (May

Pets Name

Picture Upload (May be used for a post on the website)

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Pets Name (Second pet)

Picture Upload (May be used for a post on the website) Second Pet

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Pets Name (Third Pet)

Picture Upload (May be used for a post on the website) Third Pet

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Age Verification

Photo Disclaimer

I hereby grant permission to the Lee County Sheriff's Office (LCSO) and its agents, employees, and assigns the irrevocable and unrestricted right to reproduce my photos, images, or statements shared with LCSO for its Animal Cruelty Ambassadors. I release LCSO from any and all liability that may arise from the use of such photos or statements in any publications, news releases, promotional materials, online and in print and in any other communication or publicity related to the mission of LCSO or the LCSO’s Animal Cruelty Ambassadors.