DOG LIABILITY WAIVER

Dog Owner/Handler Name: ___________________________________________________________________________________________________ Dog(s) Name(s): ________________________________________________________________________________________________________________ I understand that my attendance in class is not without risk to myself, my dog, other family mem ers or guests, and other class !artici!ants (human or canine)" #hese include, without limitation, risks of !hysical in$ury, mental in$ury, emotional distress, trauma, death, contact with other !artici!ants and their dogs, and !ro!erty damage" %ll risks are known and a!!reciated y me" I wai&e any and all s!ecific notice of the e'istence of the risks" I shall assume res!onsi ility for and !ay my and my dog(s medical and emergency e'!enses in the e&ent of in$ury, illness, or other inca!acity regardless of whether I authori)ed such e'!enses" I agree that I, as owner of the a o&e dog(s), am solely res!onsi le for the dog(s) eha&ior and !hysical control and agree to carefully monitor and control it at all times" *y reading, signing and dating this document, I here y wai&e and release +et(s ,!eak Dog, its owner (+ia ility -ai&er), Dr" +ia ility -ai&er and/or owners of any or all !remises on which these classes are held, and/or its em!loyees, agents and &olunteers of said owners, from any and all damages, losses, fines, claims, suits, e'!enses (including attorney fees and defense costs), $udgments and/or lia ilities of any form or nature resulting from any act or omission of any dog or dog owner !artici!ating in the classes conducted at +et(s ,!eak Dog and/or under the aus!ices of Dr" +ia ility -ai&er" #his release of lia ility includes, ut is not limited to any in$ury, death, sickness or !ersonal in$ury or !ro!erty damage my dog or I may suffer while on or around the !remises where the instruction is held" #his release also includes s!ecifically, ut without limitation, any and all forms of !ersonal in$ury (including death) and !ro!erty damage to myself, other !ersons, and other animals resulting from the act or omissions of any and all dogs or dog owners and I e'!ressly assume the risk of such damages or in$uries and losses throughout the duration of the curriculum" I also agree to defend, indemnify and hold harmless +et(s ,!eak Dog and its owner, (.enee Hall), Dr" /ennifer -eeks, and 0heryl -eeks and/or owners of all !remises on which these classes are eing held, and/or the em!loyee(s agents, and &olunteers of said owners from any and all claims, suits, losses, damages, e'!enses (including attorney fees and defense costs) $udgments, fines, !enalties and/or lia ilities, due to any and all forms of !ersonal in$ury (including death) and !ro!erty damage which my !et or I may cause, or e alleged to ha&e caused, to any !erson, animal, or !ro!erty while on or around the !remises where the instruction is carried out, or in connection with the instruction !ro&ided y Dr" +ia ility -ai&er, their em!loyees, agents and/or .enee Hall" #his %greement to .elease and -ai&e +ia ility, Hold Harmless, Indemnify and %ssume .isk of In$ury or +oss shall sur&i&e the com!letion or termination of instruction ser&ices y Dr" +ia ility -ai&er, their em!loyees, agents, and/or .enee Hall" #his agreement is an integrated agreement which su!ersedes any !rior, contem!oraneous oral or written agreements or negotiations" #his agreement may not e modified e'ce!t through a written agreement signed y the dog owner and Dr" +ia ility -ai&er" *y my signature elow, I here y state that I fully understand and agree to the a o&e terms and conditions in consideration for the instruction ser&ices !ro&ided y Dr" +ia ility -ai&er and their em!loyees or agents" ,ignature: _________________________________________________________ Date: ___________________________________
(must e signed y a !arent or guardian if under 12)

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