Volunteer Waiver FormVolunteer WaiverName(Required) First Last Birth Date(Required) MM slash DD slash YYYY Email(Required) Phone(Required)Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code EMERGENCY CONTACT INFORMATIONIn case of emergency, I authorize APA to notify the contacts listed below:Primary Emergency ContactName(Required) First Last RelationshipPhone(Required)Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Secondary Emergency Contact:Name First Last RelationshipPhoneAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code WaiverI understand there are inherent risks in being near, handling or petting any cats, and that even generally well-behaved cats can become aggressive without warning. These risks may be greater with respect to cats at APA’s shelter. APA has little or no history on the cats in its care and does not attest to the temperament of the cats. Although reasonable efforts are made to monitor the health of APA cats, they can contract contagious diseases and can carry diseases for which they do not show symptoms. Germs can be carried home by a volunteer to his/ her pet or family members. If your pets are very young or have chronic health problems, you should discuss these risks with your private veterinarian before volunteering. If you have chronic health problems, you should discuss the risks from animal disease with your personal physician before volunteering. Having read and understood the above, I release and agree to hold harmless APA and other volunteers, from and against any and all loss, personal injuries, property damage, claims, liability, costs and expenses of any nature whatsoever, including, without limitation, attorneys’ fees and disbursements (collectively, “Losses”), arising from or occasioned by my participation as a APA volunteer, whether at the APA shelter, the PetSmart adoption center, Thrift Store or any off-site location, including any Losses arising out of any negligence of APA or its agents, or other volunteers. I also agree not to sue or actively support any legal action against APA or other volunteers, in connection with any Losses arising from or occasioned by participation of any person as a APA volunteer at the APA shelter, PetSmart adoption center, Thrift Store or any off-site location. I certify that I either have health insurance that would cover any injury received while participating as an APA volunteer, or, should I not have insurance, I agree to be responsible for my own medical bills. To the best of my knowledge, I do not have any animal-related allergies or other medical or psychological condition that would make it inappropriate or dangerous (for myself, the cats or others) for me to participate as a APA volunteer. In the event I require medical care on an emergency basis, I authorize APA or other volunteers to seek such care on my behalf and at my expense. I agree to abide by APA policies and safety rules while serving as a volunteer.Signature(Required)HiddenCurrent Date MM slash DD slash YYYY CAPTCHA
