Jefferson County Humane Society Volunteer Waiver, Release, and Indemnification Agreement
This agreement is entered into with The Jefferson County Humane Society (JCHS) jointly by the undersigned , in order to permit the Volunteer to participate in the shelter volunteer program. This Agreement is for the benefit of JCHS and each of its staff members, employees, officers, directors, agents, and representatives (known individually as an “Indemnitee ” and collectively as “Indemnitees”). Volunteers have been advised that the activity of working with the shelter animals is hazardous and involves contact with animals that are unpredictable. As such, the Jefferson County Humane Society cannot be held liable for injuries or accidents that may occur as a result of working with the animals. Volunteers understand that the following are some, but not all, of the risks associated with working with shelter animals:
• Bites or scratches from animals
•Being knocked down or pulled excessively by a dog
• Injuries relating to wrist/hand/fingers from a dog leash
• Slips/trips/falls resulting from wet floors/kennels or equipment
• Hitting heads on objects such as cage doors/kennel walls/hose boxes, etc.
• Water or cleaners sprayed in eyes
• Injuries resulting from cage doors, equipment, etc.
• Flea/tick bites or ring worm infestation Internal or external parasites
• Zoonotic illnesses (human illness contracted from animals)
• Animal illness exposure to animals at home
• Injuries related to lifting animals, food, litter, or equipment
• Injuries caused from grooming equipment such as clipper blades, shears, driers
• Exposure to cleaners, latex gloves, bleach, parasite control products
• Exposure to or incidents relating to the public (outbursts, inappropriate contact)
• Exposure to or incidents relating to the volunteers (outbursts, inappropriate contact)
• Loss of personal property
• Any type of damage to car while parked on JCHS grounds
• Damage to clothing from animals, cages, chemicals, etc.
Volunteers are aware that injuries, loss of or damage to personal property, and death may occur as a result of Volunteer’s participation at the shelter. Volunteers agree that JCHS and Indemnitees shall not be held responsible or liable for any personal injury or other injury, including death; damage, loss, or expense to Volunteer or his/her property, whether or not such injury, death, damage, loss, or expense is caused by negligence of JCHS, any Indemnitee, or a third party. Volunteers and their heirs, executors, and administrators agree to hold harmless each Indemnitee against any and all manner of legal actions, such as suits, debts, claims, or liability of any kind incurred while the Volunteer participates at the shelter. Volunteers fully, completely, and unconditionally waive and release each Indemnitee from all rights, liabilities, duties, claims, charges, demands, actions, damages, costs, attorney fees, or expenses of any kind that Volunteers may have now or in the future against JCHS or any Indemnitee relating to participation at the shelter. Volunteers represent and warrant that he/she is physically and mentally fit to safely work with animals and public at the shelter. Should an accident or other medical emergency occur while participating at the shelter or while Volunteer is en route to or from JCHS sponsored events and JCHS staff members are unable to timely reach Emergency Contacts for medical authorizations, then Volunteer hereby gives consent for JCHS staff members to authorize necessary hospitalization and medical treatment, including but not limited to, injections, anesthesia, surgery, and medication. (page 1 of 2) Medical Insurance: Volunteer represents and warrants that Volunteer has current medical insurance coverage and agrees to be responsible for any and all billings and debts incurred with respect to such medical treatment or services.
Phone number of Insurer
Name of Physician
Phone Number of Physician
Parent or Guardian signature if under 18
Parent or Guardian phone number
BY TYPING IN MY NAME BELOW AND SUBMITTING THIS FORM, I CERTIFY THAT I HAVE READ THE VOLUNTEER WAIVER FORM AND THE INFORMATION I HAVE GIVEN IS TRUE
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