Circle Tail Volunteer Contract and Liability Waiver for Adults


I wish to volunteer for Circle Tail, Inc. (“CTI”), a non-profit public charity that, among other things, provides assistance dogs to people with disabilities and strengthens the human-canine bond through educational programs, dog training, and adoption of career-change dogs. I understand that my responsibilities may include the fostering, handling, caring, training, feeding, cleaning, and exercising of puppies and dogs on the premises of CTI at 8834 or 8778 Carey Lane, Pleasant Plain, OH or at my home or other off site locations, including, without limitation, in public or private facilities.

I have had an opportunity to review the CTI premises and operations and to question CTI Executive Director, Marlys Staley, or designated volunteer about CTI and its volunteer program. I agree that CTI will not be liable for any injury or loss sustained by me, my heirs, successors, spouses, agents, executors, legal representatives, administrators and assigns at CTI or as a result of my volunteer activities with CTI off site. I agree to notify CTI directly, in writing, if, at any time, I wish to revoke this contract. I am at least 18 years old.

The following fields are required. Please use "none" or "NA" for not applicable as appropriate.

Name:
Street Address:
City, State & Zip:
Home Phone:
Work Phone:
Cell Phone:
Email that you check:
  Emergency Contact:
Name:
Relationship:
Phone:

Please check the appropriate boxes. (At least one box must be checked.)
I am interested in:

On-Site   Off-Site
Handling Dogs at CT   Dog Transporter
Volunteer Captain   Booth/Event Participation
Kennel Work   Grant Writing
Adoption Counselor   Event Planning/Fundraising
Maintenance   Speaking Engagements
     
Foster    
Foster Family   Other:

Waiver of Liability, Assumption of Risk and Indemnity Agreement

In consideration for entry onto the premises of CTI at 8834 and 8778 Carey Lane (the “Premises”) and/or participation in CTI 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:

  1. Waiver: I hereby release CTI, 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.

  2. 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.

  3. 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 CTI, including, without limitation, relating to the Activities.

  4. 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.

I agree to and sign the Volunteer Contract including the Acknowledgement of Understanding by typing "YES" in this box: and inserting the date here:

Consent to Photograph

I hereby give permission to CTI, and/or parties designated by CTI, to photograph me 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.

Yes No

Once you have completed all required fields and clicked Submit, you will see a Thank You page. If you have not completed all required fields, you will be asked to complete the required fields before the form can be submitted and you see the Thank You page.

Having Difficulties?

If you are having difficulties submitting this form, you are welcome to print and fax it to 513-277-6064. Please make sure all the appropriate blanks are clearly completed. We would appreciate knowing the details of the difficulties you had, so we can correct problems. Please email us at admin@circletail.org.

Circle Tail, Inc.
8834 Carey Lane
Pleasant Plain, OH 45162