Name *

First Name

Last Name

Department Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

I acknowledge that this Accident Waiver and Release of Liability Form will be used by the event holders, sponsors, and organizers of the activity in which I and my dog may participate, and that it will govern my actions and responsibilities at said activity. *

Agree

I hereby assume all of the risks (to myself and my dog) of participating in any/all activities associated with ZANE DOGS, LLC, 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. *

Agree

In consideration of my application and permitting me and/or my dog to participate in this activity, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows: (A) 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, or actions of any kind which may hereafter occur to me or my dog including my traveling to and from this activity, THE FOLLOWING ENTITIES OR PERSONS: Steven C. Stoops, ZANE DOGS LLC, and/or their directors, officers, employees, volunteers, representatives, and agents, and the activity holders, sponsors, and volunteers; (B) INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in this activity, whether caused by the negligence of release or otherwise. I acknowledge that they are NOT responsible for the errors, omissions, acts, or failures to act of any party or entity conducting a specific activity on their behalf. *

Agree

INHERENT RISKS AND LIMITATIONS OF TRAINING: ZANE DOGS philosophy for effective handler/canine training requires “hands-on” participation in order to develop the skills and judgment necessary to be a functional K9 team resource. Participants need to evaluate whether their level of physical fitness and/or the level of fitness of their dog will not put them at additional risk while participating in the ZANE DOGS workshops, training activities, classes, etc. Consideration should be given for sickness, illness, health conditions or physical impairments which could be aggravated by participation in this training. I acknowledge that it is my sole responsibility to determine whether myself and/or my dog are/is physically able to participate in the class and to exclude myself and/or my dog from any activity in which we are physically unable to participate. *

Agree

ASSUMPTION OF RISK, CONSENT TO MEDICAL CARE, AGE OF PARTICIPANT: Participant fully and voluntarily assumes all risks to themselves and/or their dog in connection with the Training, the use of the Training, or any Emergency. Participant hereby consents to any medical, hospital or surgical diagnosis, treatment or care that may be necessary as a result of his or her participation in the Training, and Participant agrees to accept sole responsibility for all applicable fees, expenses or charges for any such diagnosis or treatment, including any evacuation and/or rescue costs. Participant certifies that he or she is 18 years of age or older. *

Agree

NO REPRESENTATIONS AND WARRANTIES: Participant acknowledges and agrees that ZANE DOGS has not made and is not making, any representations, statements, inducements, warranties, or guaranties other than those contained in this Voluntary Release of Liability and Notice of Assumption of Risk, with respect to the Training provided to Participant, and Participant hereby waives all remedies, warranties, guaranties or liabilities, express or implied, with respect to the Training provided to Participant, arising by law or otherwise. *

Agree

RELEASE, DISCHARGE AND COVENANT NOT TO SUE: Participant, on behalf of himself or herself and his or her heirs, executors, administrators or assigns, hereby releases ZANE DOGS, its officers, agents, employees, volunteers, and any other owner or provider of facilities at which or with which such Training is conducted (collectively “Releasees”) from any and all claims and liability arising out of the acts or omissions, including without limitation the ordinary negligence of Releasees which causes any injury, death, permanent disability, economic damages or property damage to Participant wherever or however the same may occur and Participant hereby covenants not to sue Releasees on any such claim. Participant hereby covenants to hold Releasees harmless and indemnify Releasees for any claim, judgment or expense arising out of any emergency involving Participant. *

Agree

SEVERABILITY; GOVERNING LAW: If one or more of the provisions of this Voluntary Release of Liability and Notice of Assumption of Risk is hereafter declared invalid or unenforceable, the parties hereto agrees that the invalidity or unenforceability of any of the provisions shall not in any way affect the validity or enforceability of any other provisions of this document. This Voluntary Release of Liability and Notice of Assumption of Risk shall be construed in accordance with the laws of North Carolina. *

Agree

PHOTO/VIDEO RELEASE: I understand while participating, I and/or my dog may be photographed. I grant ZANE DOGS unlimited use of photography or videography taken during the course of the Training to be used for any legitimate purpose by the activity holders, producers, sponsors, organizers, and assigns. I understand that there shall be no payment, royalty, fee, or other compensation to me by reason of such use. I understand that with my authorization below the photograph(s) may never be revoked. *

Agree

Disagree

CONSENT: BY COMPLETING THIS FORM, I CERTIFY THAT I HAVE READ THIS DOCUMENT AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY, AN ASSUMPTION OF RISK, AND AN AGREEMENT TO INDEMNIFY ZANE DOGS LLC. I SIGN THIS DOCUMENT FREELY AND VOLUNTARILY WITHOUT INDUCEMENT. *

DIGITAL SIGNATURE

First Name

Last Name

Date *

MM

DD

YYYY