Waiver

 

Please print and complete the Waiver below and bring it with you on August 31. If you do not have access to a printer, we will have a supply of waivers available at the event and would be pleased to provide one to you.

RELEASE AND INDEMNITY TO:

The Participant set forth below.

 

We understand that you (the "Participant") would like to participate in the Pooch Plunge event (the "Event") to be held on Sunday, August 31, 2008. Please know that [London Dog Owners Association, London Area Food Bank] (together, the "Sponsors") are unable to and do not accept any liability or responsibility whatsoever for any damages or injuries sustained by you or your dog while attending the Event, whether occasioned by the conduct of other dogs, their owners or otherwise. By signing below, and in consideration of our allowing you and your dog to attend and participate in the Event, you hereby: (a) release the Sponsors from any liability whatsoever in respect of any damages or injuries which you or your dog may suffer while attending or participating in the Event; and, (b) agree to indemnify and hold the Sponsors harmless from all claims, damages or injuries arising out of any act occasioned by you or your pet. Please know that the Sponsors reserve the right to remove any persons or dogs from the Event for any behavior, which the Sponsors may, in their discretion, deem inappropriate. Without in any way limiting your release and indemnification of the Sponsors as provided for above, by signing below you, additionally and specifically, agree as follows:

 

I,_________________, hereby release the Sponsors from (and acknowledge and agree that the Sponsors accept no responsibility whatsoever for) any and all claims I may have for any damages or injuries resulting from or during my and/or my dog's participation in the Event, however occasioned, including, without limitation, if occasioned by the conduct or actions of any persons or dogs who may also be participating in or organizing the Event.

 

I, ________________, accept full responsibility for my conduct and that of my dog at all times and hereby agree to indemnify and hold the Sponsors harmless, from any or all claims, damages or injuries which they may suffer or incur, whether directly or indirectly, as a result of my or my dog's actions and/or participation in the Event. This includes any liability for damages suffered by others because of any conduct or action by my dog or myself.

 

We hope you enjoy the Event.

Sincerely,

London Dog Owners Association

London Recreation Department

London Area Food Bank

 

Signature of Participant :______________________________________ Date:_______________

Paid $5.00 Fee _______________

Name of Participant:(First)_________________ (Last)________________________ Participant's Address:_________________________________________________ Participant's Phone No:______________________

Vaccination Proof required. Name of Veterinarian:________________ Date:_______________ London Dog License # :___________________________

Dog's Name:_____________________

Age:_____________ Breed:__________________

Gender: M or F

Neutered/Spayed: Y or N