Doggy Day Out Waiver
First Name
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Last Name
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Phone Number
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Email Address
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Date of Birth
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Do you plan to bring or interact with your other pets during your Doggy Day Out?
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No
Yes
If yes, please list their names, breeds, and ages.
Are all of your pets spayed/neutered/fixed?
Yes
No
N/A
Are your pets current on their vaccinations?
Yes
no
n/a
What size dog are you comfortable taking for a Doggy Day Out? Check all that apply.
Under 20 pounds
20-40 pounds
40-60 pounds
60+ pounds
I understand that working with animals carries a risk of injury, and it is possible that my family and/or guests may be bitten, scratched and/or otherwise injured.
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No
Yes
I acknowledge and understand that as a volunteer of the Charming Pet Rescue, I am not covered by workers’ compensation or any other insurance policy through the Charming Pet Rescue for any damages or injuries I may sustain during volunteer activities. I understand that I am responsible for obtaining health insurance coverage through an independent health insurance company.
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No
Yes
I understand that because I may handle and/or come in contact with animals, it is important to discuss being vaccinated against tetanus with my physician. I release the Charming Pet Rescue from all responsibility that may occur because of my not pursuing this matter further and I understand whatever decision I make is at my own risk. I have read, understand and agree to the above tetanus information.
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No
Yes
I will check the dog for properly fitting collar WITH the rescue's tag and/or put a harness on the dog before leaving the rescue.
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No
Yes
I understand that the dog is my responsibility while off the rescue premises and will keep the dog leashed.
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No
Yes
I will keep the dog safely secured and tethered in the car during transport to and from the rescue.
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No
Yes
I understand that Charming Pet Rescue will not cover expenses for any grooming or extra treats I get for the dog.
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No
Yes
Charming Pet Rescue will not be held responsible for any property damage (upholstery, carpets, etc) or illnesses caused to other pets on these outings.
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No
Yes
I agree not to leave the dog unattended in a car for any length of time to prevent heat exhaustion.
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No
Yes
I agree to provide water to the dog throughout the Doggy Day Out and I will pick up after him/her.
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No
Yes
My signature to this volunteer liability release attests to my intent to hold harmless and release from all liability Charming Pet Rescue or any of its past, present or future Officers, agents, volunteers, employees or assigns, from all acts which are related to the normal performance of required and implied duties. My signature, whether original, by fax or any other electronic means, is valid as if it were an original signature.
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No
Yes
Please type your name for an electronic signature if you agree to all of the above terms and conditions, and if all of the information you provided is accurate and truthful.
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