Waiver and Release of Liability, Assumption of Risk and Indemnity Agreement

Waiver and Release of Liability, Assumption of Risk and Indemnity Agreement
Name*

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number
Pet(s) Name*
Name(s)
Pet Information*

Dog BreedDogs WeightAge of Dog
Vet Information

NamePhone Number
In consideration of being allowed to use in any way in the dog washing area of JRLN, Inc., d/b/a Perk-N-Pooch, you acknowledge, appreciate, and agree that:

1. I HEREBY ACKNOWLEDGE THAT THE DOG WASHING AREA MAY BE DANGEROUS AND ASSUME ALL OF THE RISKS OF USING THE DOG WASHING AREA, including by way of example and not limitation, any risks that may arise from negligence or carelessness on the part of the persons or entities being released,from dangerous or defective equipment or property owned, maintained, or controlled by them, or because of their possible liability without fault. The risks of using the dog washing area may include but are not limited to: property damage (including injury or death to other dogs), personal injury or death due to slipping, falling, or interaction with other dogs.

2. I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for my death, disability, personal injury, property damage, property theft, dog injury or actions of any kind which may hereafter occur to me, THE FOLLOWING ENTITIES OR PERSONS: JRLN, Inc., d/b/a Perk-N-Pooch, and/or its directors, officers, employees, volunteers, representatives, agents, and owners or lessors of the premises used (hereinafter the “Releasees”).

3. I INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the Releasees from any and all liabilities or claims made as a result of the use of the dog washing area, whether caused by negligence or otherwise of the Releasees.

4. I agree that this Waiver and Release of Liability, Assumption of Risk and Indemnity Agreement extends to all acts of negligence by the Releasees and is intended to be as broad and inclusive as is permitted by the laws of the State of Georgia and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

5. I hereby acknowledge, attest and certify that my dog(s):
1) is/are in good health and has/have not been ill with any communicable condition in the last 15 days, 2) does/do not have fleas, 3) has/have not harmed or shown or threatening behavior (i.e. biting or attacking) towards any person or
dog. The staff may at any time remove a dog from the premises if he/she exhibits behavior which could be harmful to other dogs or persons.

6. I hereby grant to JRLN, Inc., d/b/a Perk-N-Pooch, Photographer, his/her legal representatives, heirs and/or assigns, those for whom Photographer is acting, and those acting with his/her authority and permission (collectively “Photographer”), the absolute right and permission to copyright and use, re-use, and publish, photographic portraits or pictures of me, family members, pet or in which I may be included, in whole or in part, or composite or distorted in character or form, without restriction as to changes or alterations from time to time, in conjunction with my own or a fictitious name, or reproductions thereof in color or otherwise, made through any medium at his/her studios or elsewhere, and in any and all media now or hereafter known, for art, advertising, trade or any other legal purpose. I also consent to the use of any printed matter in conjunction therewith.

7. I hereby waive any right that I may have to inspect or approve the finished product or products or the advertising copy or printed matter that may be used in connection therewith or the use to which it may be applied.

8. I hereby release, discharge and agree to hold harmless JRLN, Inc., d/b/a Perk-N-Pooch, Photographer from any and all liability that has or may occur or be produced in the taking of said pictures or any subsequent process thereof, as well as any publication thereof.

9. I hereby acknowledge that the fair market value of my pet is $100.00.

10. I agree that this waiver is made in accordance with and governed by the laws of the State of Georgia.

I HAVE READ THIS RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND HAVE SIGNED IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT, ASSURANCE, OR GUARANTEE BEING MADE TO ME AND INTEND MY SIGNATURE TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE
GREATEST EXTENT ALLOWED BY LAW.
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