Name
*
First Name
Last Name
Phone
*
(###)
###
####
Email
*
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Emergency Contact
*
First Name
Last Name
Emergency Contact Phone
*
(###)
###
####
Parent/Guardian Full Name
First Name
Last Name
Parent/Guardian Number
(###)
###
####
What days and times of the week are you available to volunteer?
Check all that apply
Are you volunteering to receive community or volunteer hours?
*
No
Yes
Possibly
Will you be able to only promote RRInc’s training and behavior methods while working as a Volunteer under RRInc.?
*
Yes
No
If you answered None above, are you willing to go through Education and Responsible Owner courses?
Yes
No
Do you currently have any pets?
*
Check all that apply. If yes, please provide details in the next section.
List Pet Details Below: Species (dog/cat/etc.), Breed, Age, Gender (M/F), Spayed/Neutered?
Have you recently lost any pets?
*
Yes
No
Have you ever been arrested for animal cruelty or negligence?
*
Yes
No
What would you like to get out of volunteering with Rugaz Rescue?
*
How did you hear about Rugaz Rescue, Inc?
*
Facebook/Twitter
Web Search
Word of Mouth
Local Event
TV/Radio
Flyer/Poster/Newsletter/E-Mail
Please leave any comments or questions you may have below:
Agree to Terms and Conditions
*
I ACKNOWLEDGE, agree, and represent that I understand the nature of Rugaz Rescue, Inc activities and that I am qualified, in good health, and in proper physical condition to participate in such Activities. I further agree and warrant that if at any time I believe conditions to be unsafe, I will immediately discontinue further participation in such Activity at that time.
FULLY UNDERSTAND THAT: (a) of Rugaz Rescue, Inc ACTIVITIES MAY INVOLVE RISKS AND DANGERS OF PERSONAL INJURY, (b) these Risks and dangers may be caused by my own actions or inaction’s, the actions or inaction’s of others participating in the Activity, the condition in which the Activity takes place, or THE NEGLIGENCE OF THE “RELEASEES” NAMED BELOW; (c) there may be OTHER RISK AND SOCIAL AND ECONOMIC LOSSES either not known to me or not readily foreseeable at this time; and I FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES, COSTS, AND DAMAGES I incur as a result of my participation in the Activity.
HEREBY RELEASE, DISCHARGE, AND COVENANT NOT TO HOLD of RUGAZ RESCUE, INC, their respective administrators, directors, agents, officers, members, volunteers, and employees, other participants, any sponsors, advertisers, and, if applicable, owner and lessors of premises on which the Activity takes place, (each considered one of the “RELEASEES” herein) FROM ALL LIABILITY, CLAIMS, DEMANDS, LOSSES, OR DAMAGES ON MY ACCOUNT CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE “RELEASEES” OR OTHERWISE, INCLUDING NEGLIGENT RESCUE OPERATIONS AND I FURTHER AGREE that if, despite this RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT I, or anyone on my behalf, makes a claim against any of the Releasees, I WILL INDEMNIFY, SAVE, AND HOLD HARMLESS EACH OF THE RELEASEES from any litigation expenses, attorney fees, loss, liability, damage, or cost which may incur as the result of such claim.
I HAVE READ THIS AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND HAVE SIGNED IT FREELY AND WITHOUT INDUCEMENT OR ASSURANCE OF ANY NATURE AND INTEND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW AND AGREE THAT IF ANY PORTION OF THIS AGREEMENT IS HELD TO BE INVALID THE BALANCE, NOTWITHSTANDING, SHALL CONTINUE IN FULL FORCE AND EFFECT.
