Minor Volunteer Permission Slip and Liability Waiver

Volunteer Permission Slip and Liability Waiver for Minor

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Parent or Guardian of the Minor Child: *

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The below named minor is my child or ward and wishes to volunteer for Circle Tail, Inc., a non-profit public charity that, among other things, provides service and hearing dogs for people with disabilities and strengthens the human-canine bond through educational programs, pet first aid classes, dog training services, and adoption of career-changed dogs. I understand that his/her responsibilities may include the fostering, handling, caring, training, feeding, cleaning, and exercising of puppies and dogs, and other activities related to Circle Tail or Circle Tail dogs. I further understand that his/her volunteer services may occur on the premises of Circle Tail at 8834 or 8778 Carey Lane, Pleasant Plain, OH, at home, or at any off-site location where a Circle Tail activity takes place, including, without limitation, in public or private facilities. I have had an opportunity to review the Circle Tail premises and operations and to question Circle Tail's Executive Director, Marlys Staley, about Circle Tail and its volunteer program. Minor's Name: *

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Minor's Date of Birth *

I am the minor's: *

Parent
Legal Guardian

Parent or Guardian's Address: *

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Parent or Guardian's Home Phone: *

Parent or Guardian's Work Phone: *

Parent or Guardian's Cell Phone: *

Parent or Guardian's Email: *

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Emergency Contact Relationship to Parent or Guardian: *

The above named minor child has my permission to participate in the Circle Tail volunteer program and I agree that Circle Tail will not be liable for any injury or loss sustained by him/ her at Circle Tail or as a result of his/ her volunteer activities with Circle Tail, including, without limitation off site. I agree to notify Circle Tail directly, in writing, if, at any time, I wish to revoke this permission. *

I hereby give permission to Circle Tail, and/or parties designated by Circle Tail, to photograph my son/ daughter/ ward named above, for still and video photography, and to use such photographs in all forms of media, for any and all promotional purposes including, but not limited to, advertising, publicity, display, audiovisual, exhibition, commercial, or editorial use. *

Waiver of Liability, Assumption of Risk and Indemnity Agreement

In consideration for entry onto the premises of Circle Tail, Inc. at 8834 and 8778 Carey Lane (the ”Premises”), and/or participation in Circle Tail activities, including, without limitation, fostering a dog(s) at home and/or taking a dog(s) to a public or private facility (collectively, the “Activities”), I for myself, my heirs, successors, spouses, agents, executors, legal representatives, administrators, assigns, and/or my minor child/ward where applicable, do hereby agree as follows:

Waiver: I hereby release Circle Tail, Inc., Marlys Staley, and all promoters, sponsors, volunteers, shareholders, directors, officers, representatives, affiliates, members, successors, agents, assigns, employees, or others connected with CTI (collectively, “Releasee”) from any and all liability for, waive any right to bring suit against Releasee relating to, and covenant not to sue Releasee for, any and all claims, including claims arising from negligence, resulting in personal injury, accidents, illnesses (including death) and property loss, arising out of or connected in any way with entry onto the Premises or participation in the Activities.
Assumption of Risks: I acknowledge that entry onto the Premises and/or participation in the Activities carries with it certain inherent risks to people, animals and property. Such risks include, but are not limited to, animals that can bite, scratch, trip, knock down and fight, indoor and outdoor surfaces that may be slippery, equipment that can trip, persons who cannot control their dogs and activities involving dogs that can result in injury from bites, scratches, and other causes.

I have read the preceding paragraph and know, understand and appreciate these and other risks inherent in entering the Premises and participating in the Activities. I hereby assert that participation by me and/or my minor child/ward is voluntary, and I knowingly assume all such risks.
Indemnification and Hold Harmless: I also agree, on behalf of the same above-referenced parties, to INDEMNIFY AND HOLD Releasee HARMLESS from any and all claims, actions, suits, procedures, costs, expenses, damages and liabilities, including attorney's fees, brought as a result of my or my child/ward's involvement in volunteering for Circle Tail. Inc., including, without limitation, relating to the Activities.
Severability: The undersigned further expressly agrees that the foregoing waiver and assumption of risk agreement is intended to be as broad and inclusive as is permitted by the laws of the State of Ohio and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

Acknowledgement of Understanding and Signature

I have read the foregoing Waiver of Liability, Assumption of Risk and Indemnity Agreement and fully understand its terms. I understand that I am giving up substantial rights, including my right to sue. I am signing this agreement freely and voluntarily. As parent or guardian, I agree to and sign the Permission Slip including the Acknowledgement of Understanding by typing yes in this box: *

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