VOLUNTEER REGISTRATION, WAIVER OF LIABILITY AND INFORMED CONSENT
National Association of Canine Scent Work, LLC® NW3 & NW2 Trials
Saturday, March 27 & Sunday, March 28, 2021
Full Name
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First Name
Last Name
Cell Phone
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-
Area Code
Phone Number
Email
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example@example.com
VOLUNTEER TIMES: PRIORITY WILL BE GIVEN TO FULL DAY VOLUNTEERS. WE WILL ADD HALF DAY VOLUNTEERS, AS NEEDED.
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Can we use your vehicle for our search? Check in is at 7:00 am each day? If yes, please state type, color, model.
I agree (check box)
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I understand that I am participating at an event in the time of COVID-19 and that I have reviewed the COVID-19 event guidelines provided by the NACSW Event Guidelines that is located in Google docs and was emailed to the membership on 5/8/2020. In addition, I agree to wear a face covering anytime that I am outside my vehicle. I understand that check in will be done in my vehicle and that I am required to wear a face mask at this time. I understand that there is no exception to the face mask requirement. I also understand that I am required to remain in my vehicle as much as possible, will not be able to "gather" and will maintain minimum of 6 foot distance from others at all times. I agree to waive, release, indemnify, and hold harmless Amy Herot, Jill-Marie O’Brien, Ron Gaunt, K9 Nose Work®, National Association of Canine Scent Work, LLC®, imPETus Animal Training, Holistic Hounds LLC, Veronica Selco, Impetus Animal Training and their Employees, Officers, Directors, Agents, or Contractors, including facilities we use, from any and all damages or personal injury.
I agree (check box)
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I understand that the behavior of dogs cannot be guaranteed. I also understand that the behavior of domestic animals is sometimes unpredictable and that some domestic animals are capable of inflicting serious personal injury or death, as well as extensive property damage. Knowing the risks I agree to assume ALL those risks including, but not limited to; assuming the financial responsibility of any possible litigation arising from any incident in which I may be involved. I release, indemnify, and hold harmless Amy Herot, Jill-Marie O’Brien, Ron Gaunt, K9 Nose Work®, National Association of Canine Scent Work, LLC®, imPETus Animal Training, Holistic Hounds Training, Holistic Hounds LLC, Veronica Selco and their Employees, Officers, Directors, Agents, or Contractors from any and all damages or personal injury. Any incident involving myself, the location, or those pets or actions of other participants and spectators will be my sole responsibility and I assume all financial liability and will also assume all and any financial costs associated with my actions.
I agree (check box)
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In addition to the above, I understand that participating in this event, even as a volunteer or spectator holds some risk. My dog and I may be exposed to challenging, treacherous or unstable footing and accept all possible risks associated with participating or observing any type of detection style training or competition. I agree to hold harmless Amy Herot, Jill-Marie O’Brien, Ron Gaunt, K9 Nose Work®, National Association of Canine Scent Work, LLC®, imPETus Animal Training, Holistic Hounds Training, Holistic Hounds LLC, Veronica Selco and their Employees, Officers, Directors, Agents, or Contractors including, but not limited to, the event location’s agents or owner and to accept responsibility for all litigation and financial obligations arising from any unforeseen event in which I may be involved.
I agree (check box)
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In addition to the above, at the time of my participation at the event, I represent and affirm that: (1) I do not have COVID-19 nor am I waiting for test results; (2) I have not been tested and found positive for COVID-19 or if I have tested positive for COVID-19, I certify that I have been released by government officials and/or health care providers to resume normal activity without limit; (3) I have not during the past 14 days experienced symptoms associated with COVID-19 including fever, coughing, or shortness of breath; and (4) I have not within the past 14 days, to the best of my knowledge and belief, been in contact with or exposed to any known carrier of COVID-19. I understand the risks of contracting or being exposed to COVID-19 associated with my attendance at a training session. I agree to waive, release, indemnify, and hold harmless Amy Herot, Jill-Marie O’Brien, Ron Gaunt, K9 Nose Work®, National Association of Canine Scent Work, LLC®, imPETus Animal Training, Holistic Hounds LLC, Veronica Selco, Impetus Animal Training and their Employees, Officers, Directors, Agents, or Contractors, including facilities we use, from any and all damages or personal injury.
I agree (check box)
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In addition to the above, any incident involving myself, the location, or other pets or actions of other participants and spectators will be my sole responsibility and I assume all financial liability and will also assume all and any financial costs associated with my actions.If I am to bring another family member to assist me to a training session, I affirm and take full responsibility for their health and well-being. I understand the risks of contracting or being exposed to COVID-19 associated with my attendance at a training session. I agree to waive, release, indemnify, and hold harmless Amy Herot, Jill-Marie O’Brien, Ron Gaunt, K9 Nose Work®, National Association of Canine Scent Work, LLC®, imPETus Animal Training, Holistic Hounds LLC, Veronica Selco, Impetus Animal Training and their Employees, Officers, Directors, Agents, or Contractors, including facilities we use, from any and all damages or personal injury.
I agree (check box)
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In addition to the above, I understand that video recording or photography may be taken and used for educational or public relations, marketing and social media.
I have read, understand and agree to the above:
Signature (use mouse or finger)
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Today's date
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Minor's name
Parent name
Parental consent:
I am the lawful parent and/or legal guardian of the above named minor. I acknowledge that I have read and understand this Liability Waiver and that I and the above named minor will be bound by said Liability Waiver.
Parent signature
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© Copyright 2012 Amy Herot, Jill Marie O’Brien and Ron Gaunt. All Rights Reserved.
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