2. First Name*
3. Last Name*
5. Address 1*
7. Address 2
9. City*
10. State*
11. Zip*
13. Phone Number*
14. Phone Type

    1. Home
    2. Mobile

    1. Work
    2. Other
16. ACC Animal Services Volunteer and Community Programs Participant, Release and Waiver of Liability

    (Please read all text and fill out all required portions of this form.)

18. This Community Programs Participant Agreement, Release, and Waiver of Liability ("Release") executed on:*
    This Community Programs Participant Agreement, Release, and Waiver of Liability ("Release") executed on:
20. By ("Participant"):*

    (enter your first and last name)

22. This releases the Unified Government of Athens-Clarke County ("ACCGov"), a body politic and corporate and a political subdivision of the State of Georgia being herein defined to include such governmental entity and all of ACCGov's officials, directors, officers, employees, and agents.
24. WHEREAS, Participant understands that the scope of Participant’s relationship with ACCGov is limited to a volunteer participation position and that no compensation is expected in return for services provided by Participant, that ACCGov will not provide any benefits traditionally associated with employment to Participant, and that Participant is responsible for his or her own insurance coverage in the event of personal injury or illness as a result of Participant’s services to ACCGov.
26. Waiver and Release: I, the Participant, do release and forever discharge, indemnify and hold harmless ACCGov and its successors and assigns from any and all liability, claims, and demands of whatever kind or nature, either in law or in equity, which arise or may hereafter arise from the volunteer participation I provide to ACCGov. I understand and acknowledge that this Release discharges and indemnifies and holds harmless ACCGov from any liability or claim that I or my heirs, successors, and assigns have or may have against ACCGov with respect to bodily injury, personal injury, illness, death, or property damage that may result from the volunteer participation I provide to ACCGov or that may occur while I am providing volunteer services.
28. Insurance: Further I understand that ACCGov does not assume any responsibility for or obligation to provide me with financial or other assistance, including but not limited to medical, health, or disability benefits, or insurance of any nature in the event of injury, illness, death, or damage to property that may occur while I am providing volunteer services. I expressly waive any such claim for compensation or liability on the part of ACCGov beyond what may be offered freely by ACCGov in the event of such injury or medical expenses incurred by me or others not party to this Release.
30. Medical Treatment: I hereby Release and forever discharge ACCGov from any claim whatsoever which arises or may hereafter arise on account of any first-aid treatment or other medical services rendered in connection with an emergency while I am volunteering with ACCGov. I understand and acknowledge that this Release discharges and indemnifies and holds harmless ACCGov from any liability or claim that I or my heirs, successors, and assigns have against ACCGov with respect to bodily injury, personal injury, illness, death, or property damage that may result from the volunteer services I provide to ACCGov or that may occur while I am providing volunteer services.
32. Assumption of Risk: I understand that my participation in ACCAS Programs, including general shelter volunteering, fostering, transporting, and the Doggie Day Out program (hereinafter referred to collectively as “Programs”), may include activities that may be hazardous to me and others, including but not limited to: handling frightened animals; cleaning feces, urine, and vomit; being bitten, scratched, jumped on, chased, knocked over, or tripped; moving cages and crates; bending, stooping, and lifting; walking dogs; transporting animals; transporting equipment; and other activities involved in the handling of animals. I understand that my participation in these Programs, which may involve my desire to be permitted to foster a shelter animal from ACCAS in my home, includes the risk of damage to personal property, including damage to other animals in the home, and that ACCAS cannot guarantee to me or anyone else what type of temperament the animal(s) I am fostering may have. I understand that I am not an agent of ACCGov or ACCAS, and I hereby accept responsibility for the animal(s) in my care at all times. As a volunteer, I hereby expressly assume the risk of injury or harm from participation in any Programs and release ACCGov from all liability for injury, illness, death, property damage, or other loss resulting directly or indirectly from the services I provide as a volunteer participant or foster parent to a shelter animal, or occurring while I am providing volunteer services by participating in any Programs.
34. Volunteer Responsibilities: I have read the Athens-Clarke County Animal Services Volunteer and Community Programs Guide, and accept and commit to abide by its terms, and the principles in it, while volunteering for ACCAS. I will strive to perform my volunteer duties to the best of my ability, and to keep lines of communication with shelter staff open. I understand that I am here of my own volition and I may stop volunteering at any time, and that if I exhibit behaviors considered by ACCAS staff to be dangerous or malicious to myself, ACCAS, the animals, and/or other volunteers, staff, or members of the public, I may be removed from the volunteer program.
36. Pictures: I also give permission for photos and/or videos of myself and/or my child(ren)/dependent(s), or those taken by myself and/or my child(ren)/dependent(s) to be used by ACCAS. These photos may be used in promotional efforts in support of its programs, and efforts to secure positive outcomes for shelter animals.
38. Transport Participant: I understand that my participation in the transportation of any animals is voluntary and no compensation will be given. I assume all risks and responsibility while the animal is in my vehicle. I acknowledge that this transport may be for Doggie Day Out, Fostering, and for assisting ACCAS to transfer animals to and from an offsite veterinarian or event. I understand that a copy of my automobile insurance and driver’s license must be submitted prior to transport, and will be kept on file.
40. Foster and Doggie Day Out Program Agreement:

    (Please input your initials next to each statement to show you have read and accept the terms outlined therein.)

42. Initials*
43. I agree that ACCGov will not be responsible for any accidents, injuries, illnesses of any animal(s) fostered from ACCAS or caused by said animal(s);
45. Initials*
46. I am responsible for any harm or damage caused by the animal(s) at all times when outside of ACCAS facilities;
48. Initials*
49. I have disclosed all personal animals on my Foster Application and will introduce foster animal(s) to my personal pets as described in the Foster Home Guidelines packet. I will bring any personal animal(s) to the shelter for meet and greets if requested to do so;
51. Initials*
52. I am making a commitment to this (these) animal(s). While in my care, I agree to humanely care for this (these) animal(s) by providing adequate food, water, shelter, exercise, and medical care, if necessary. I will ensure that the animal(s) wear the supplied collar and/or harness with supplied tags at all times;
54. Initials*
55. I will follow all ACCAS ordinances and state laws in regard to animals, including but not limited to, proper pet waste disposal and no unattended tethering;
57. Initials*
58. I understand that ACCAS animal(s) can only stay overnight in an approved foster home; I will not leave the animal(s) with any person other than an approved ACCAS foster or volunteer;
60. Initials*
61. I will return the animal(s) as directed by ACCAS. I will contact ACCAS staff about procedures for myself, or anyone else, interested in adopting. Failure to return the animal(s) as directed may result in criminal charges;
63. Initials*
64. I understand that ACCGov makes no claims or representations as to the behavior, health, or temperament of animals included in any of our programs;
66. Initials*
67. I will use extreme caution and supervision when out in public, in new situations, and around people and animals, especially children and any other animals. I understand that ACCAS dogs should never be left alone under any circumstances, unless properly secured within the approved foster home. I will always maintain proper control and observation over them. I understand that I should use caution when deciding to introduce a foster/shelter animal(s) to a child or another animal, and will do so as described by the Foster Coordinator or other ACCAS staff;
69. Initials*
70. I will report any behavioral or medical concerns while the animal(s) is in my care. I understand that this is essential for the safety of the animal(s), volunteers, and to the public. Should there be an urgent event, including but not limited to, escape, damage to property, a bite to a person or other animal, or ingestion of an object or unapproved food, I will contact shelter staff immediately;
72. Initials*
73. I agree that ACCAS animals will never be off-leash unless in their approved foster home and/or approved fenced in backyard or approved dog park. I am aware that the approval of my fenced in backyard is dependent on the specific foster animal(s) and cats will never be allowed outside;
75. Initials*
76. I understand that the only dog park that I may take an ACCAS dog to is one that is private, has no other dogs present, and has been pre-approved by the Foster Coordinator or ACCAS Supervisor;
78. Initials*
79. I will remain in contact with shelter staff while fostering any ACCAS animal(s) and will respond in a timely manner to any check-ins including, but not limited to, phone or email at all times;
81. Initials*
82. I have read over, understand, and agree to abide by the requirements of the Doggie Day Out and/or the Foster Home Guidelines Packet given to me;
84. Other: I expressly agree that this Release is intended to be as broad and inclusive as permitted by the laws of the State of Georgia and that this Release shall be governed by and interpreted in accordance with the laws of the State of Georgia and the United States of America. I agree that in the event that any clause or provision of this Release is deemed invalid, the enforceability of the remaining provisions of this Release shall not be affected.
86. By signing below, I express my understanding and intent to enter into this Volunteer Agreement, Release, and Waiver of Liability willingly and voluntarily.
88. Participant Name:*

    First and Last

90. Phone Number*
91. Phone Type

    1. Home
    2. Mobile

    1. Work
    2. Other
93. E-mail*
95. Agency or Organization:

    (Leave blank if acting as a private citizen)

97. Emergency Contact Name / Relationship:*
99. Emergency Contact Phone Number*
100. Phone Type

     1. Home
     2. Mobile

     1. Work
     2. Other
102. By typing my name here I agree to e-sign this document.*
104. Date Signed*
     Date Signed
Leave This Blank:


105. 1. Receive an email copy of this form.
106. Email address

     This field is not part of the form submission.

107. Submit

* indicates a required field