Date:*

Name:*

Date of Birth:*

Street Address:*

City:*

State:*

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Zip:*

Home Phone:*

Mobile Phone:*

Email:*

Emergency Contact (Name):*

Emergency Contact (Phone Number):*

This is a legal document-please read carefully and be sure you understand it before signing.

You have voluntarily applied to assist Carroll County Animal Shelter (CCAS) with the event/work indicated in the Volunteer Video that is attached and required to be viewed before agreeing to this statement.*

Accept

Decline

I am aware that this is a contract between me and CCAS and that it waives legal rights that I may have now or in the future and releases CCAS and others from claims for damages.*

Accept

Decline

I AM VOLUNTARILY PARTICIPATING IN THIS ACTIVITY WITH FULL KNOWLEDGE OF THE TASKS INVOLVED. I AGREE TO ACCEPT ANY AND ALL RISKS ASSOCIATED WITH MY PARTICIPATION, INCLUDING BUT NOT LIMITED TO INJURY AND ILLNESS.*

Accept

Decline

I understand there are risks and dangers associated with working with wild, feral and domesticated animals, included but not limited to, bites, scratches, zoonotic diseases (diseases transmitted from animals to humans), allergic reactions. I also understand there may be risks involved with exposure to certain chemical cleaning products while performing my volunteer duties. I fully understand and accept those risks and dangers.*

Accept

Decline

I fully assume all the risks involved with my volunteer activities, and acknowledge that they are acceptable to me. I agree to use my best judgement in undertaking these activities. I also agree to follow the rules and safety instructions as given by CCAS employees and volunteers authorized to act in a supervisory capacity.*

Accept

Decline

I agree that I will not sue, prosecute, or in any way make claim against CCAS for injury to me or damage to my property resulting from the negligence or other acts howsoever caused, by any employee, agent, volunteer or contractor of CCAS or other people as a result of my volunteer duties.*

Accept

Decline

I fully and forever release and discharge CCAS from any and all actions, causes of action, claims, liabilities, or demands I have or may have in the future , whether known or unknown, for injury, illness, death or damage arising out of a related in any way to my volunteer duties.*

Accept

Decline

I agree that CCAS may use my name, and pictures, photographs, or video and/or sound recordings of me on television, on radio, on the internet, in emails and in stories, news articles, advertisements, or other written or digital materials. I agree that such uses may include education, advocacy, and fundraising. I consent to authorize, in advance, such use and agree that CCAS does not have to notify me or such use or provide me with other consideration for such use. I waive any rights of privacy and/or publicity I may have in connection with these uses. *

Accept

Decline

I agree that the rights I am giving up and agreements I am making apply equally to me and to my heirs, successors, assigns, guardians and legal representatives. I agree that none of those individuals may make any claim or take any action that I could not make or take myself.*

Accept

Decline

I agree that this Waiver and Release of Liability protects and is for the benefit of CCAS and its respective employees, officers, directors, consultants, interns, volunteers, licenses, and all other acting on their behalf. I also agree that I may not make any claim or take any action against any of the above or individuals that I could not make or take against CCAS itself.*

Accept

Decline

I intend to fully and voluntarily waive any rights I have as described in the Waiver and Release of Liability. To the extent that legal consideration is required for this Waiver and Release of Liability to be effective, I agree that I have received good, valuable and sufficient consideration by being permitted by CCAS to provide volunteer service and to receive training and instruction.*

Accept

Decline

I HAVE CAREFULLY READ THIS WAIVER AND RELEASE AND FULLY UNDERSTAND ITS CONTENTS AND ACCEPT AND SIGN IT OF MY OWN FREE WILL. If I am under 18 years of age at the time of registration, my parent or legal guardian has completely reviewed this Waiver and Release of Liability, understands and consents to its terms, and authorizes my participation.*

Accept

Decline

Please watch the video link before completing.

CCAS Volunteer Video

Volunteer Full Name:*

Parent/Guardian Name (if under 18):