FLCAC Volunteer Release

This form must be completed and submitted for every participant at Friends of Lee County Animal Control before engaging in any animal related activity. It is the participant’s* responsibility to ensure that all information is complete and accurate, and to notify FLCAC in the event of any changes.

Participant's* Name

First NameLast Name

Birth Date

Date

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Home/Work Phone

Area CodePhone Number

Cell Phone

Area CodePhone Number

Email

example@example.com

Please notify the following individual(s) immediately in the event of a medical emergency:

Name

First NameLast Name

Relationship:

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Home/Work Phone

Area CodePhone Number

Cell Phone

Area CodePhone Number

List any medical conditions, medications or allergies that you would like staff or emergency personnel to be aware of:

Participant's Signature

DATE SIGNED

Date

*Participant: Any individual who knowingly participates in a Friends of Lee County Animal Control activity on or off FLCAC property, including animal handling, transport, assisting with veterinary activities, educational/fundraising activities, and any other activity at a location sponsored by FLCAC.

PLEASE READ CAREFULLY AND RESPOND TO EACH STATEMENT BELOW:

I acknowledge that I have voluntarily applied to assist Friends of Lee County Animal Control. I understand as a volunteer that I will not be paid for my services, that I will not be covered by any medical or other insurance coverage provided by FLCAC, and that I will not be eligible for any Workers Compensation benefits. I understand that I am responsible for my own insurance coverage in the event of personal injury or illness as a result of my activities with FLCAC.

YESNO

I understand that animals (including but not limited to dogs, cats, and horses) are independent living beings and that their behavior can be unpredictable. There are inherent risks to animal-related activities and animals may behave in ways that result in injury, harm, or death to persons around them.

YESNO

I acknowledge that I must treat the animals of FLCAC with respect and dignity and under no circumstances will any form of abuse (physical, verbal or otherwise) be tolerated against any animal and person. Should any of the above referenced events occur, I will no longer be eligible to participate in any volunteer activities for FLCAC.

YESNO

I will refrain from acting in any manner which may cause or contribute to my injury or the injury of other people or animals.

YESNO

In the event that emergency medical aid/treatment is required by me for illness or injury while participating in any FLCAC related activity I authorize FLCAC to secure and obtain medical treatment and/or transportation if needed. (This authorization includes any treatment / procedure deemed “life-saving” by a physician, hospital or other medical facility. This provision will only be invoked if the emergency contacts listed above cannot be reached and FLCAC must act on my behalf.)

YESNO

RELEASE:

In consideration of the opportunity afforded me to assist in patient care, I hereby agree that I, my assignees, heirs, guardians, and legal representatives, will not make a claim against Friends of Lee County Animal Control, any of their affiliated organizations, their owners or employees collectively or individually, or any of the volunteer workers, for the injury or death to me or damage to my property, however caused, arising from my participation. Without limiting the generality of the foregoing, I hereby waive and release any rights, actions, or causes of action resulting from personal injury or death to me, or damage to my property, sustained in connection with my participation. I understand that this release discharges Friends of Lee County Animal Control from any liability or claim that I may have against Friends of Lee County Animal Control with respect to bodily injury, personal injury, illness, death, or property damage that may result from services I provide or occurring while I am providing volunteer services.

I understand that Friends of Lee County Animal Control does not assume any responsibility for or obligation to provide me with financial or other assistance, including but not limited to medical, health, or disability benefits or insurance of any nature in the event of my injury, death, or damage to my property. I expressly waive any such claim for compensation or liability on the part of Friends of Lee County Animal Control beyond what may be offered freely by Friends of Lee County Animal Control in the event of such injury or medical expenses incurred by me.

I hereby release and forever discharge Friends of Lee County Animal Control any claim whatsoever which arises or may hereafter arise on account of any first-aid treatment or other medical services rendered in connection with an emergency during my tenure as a volunteer with Friends of Lee County Animal Control.

I understand that the services I provide to Friends of Lee County Animal Control may include activities that are hazardous to me including, but not limited to, handling animals and exposure to zoonotic disease. As a volunteer, I hereby expressly assume the risk of injury or harm from these activities and release Friends of Lee County Animal Control from all liability for injury, illness, death, or property damage resulting from the services I provide as a volunteer or occurring while I am providing volunteer services.

As a volunteer, I expressly agree that this release is intended to be as broad and inclusive as permitted by the laws of the state of Alabama and that this release shall be governed by and interpreted in accordance with the laws of the state of Alabama. I agree that in the event that any clause or provision of this release is deemed invalid, the enforceability of the remaining provisions of this release shall not be affected.

By signing below, I express my understanding and intent to enter into this release and waiver of liability willingly and voluntarily.

DATE SIGNED

Date

Volunteer Name

First NameLast Name

Volunteer Signature