Download EMERGENCY CONTACT AND RELEASE Emergency Contact

 EMERGENCY CONTACT AND RELEASE Emergency Contact Information
Name: ______________________________________ Relationship with child: ______________________ Address:______________________________________________________________________________ Phone: _____________________________________ Cell:______________________________________ E­mail: _______________________________________________________________________________ Any allergies, medications, or other information needed in an emergency: _____________________________________________________________________________________ 1. ​
Release and Waiver. ​
Book Buddy does hereby release and forever discharge and hold harmless Cedar Bend Humane Society and its successors and assigns from any and all liability, claims, and demands of whatever kind or nature, either in law or in equity, that arise or may hereafter arise from Book Buddy's Activities with the Cedar Bend Humane Society. 2. ​
Medical Treatment.​
Book Buddy does hereby release and forever discharge Cedar Bend Humane Society from any claim whatsoever which arises or may hereafter arise on account of any first aid, treatment, or service rendered in connection with the Book Buddy's Activities with Cedar Bend Humane Society. 3. ​
Insurance.​
The Book Buddy understands that, except as otherwise agreed to by Cedar Bend Humane Society in writing, Cedar Bend Humane Society does not carry or maintain health, medical, or disability insurance coverage for any Book Buddy. Each Book Buddy is expected and encouraged to obtain his or her own medical or health insurance coverage. 4. ​
Photographic Release.​
Book Buddy does hereby grant and convey unto Cedar Bend Humane Society all right, title, and interest in any and all photographic images and video or audio recordings made by Cedar Bend Humane Society during the Book Buddy's Activities with Cedar Bend Humane Society, including, but not limited to, any royalties, proceeds, or other benefits derived from such photographs or recordings. 5. ​
Other.​
Book Buddy expressly agrees that this Release is intended to be as broad and inclusive as permitted by the laws of the State of Iowa, and that this Release shall be governed by and interpreted in accordance with the laws of the State of Iowa. Book Buddy also agrees that in the event that any clause or provision of this Release shall be held to be invalid by any court of competent jurisdiction, the invalidity of such clause or provision shall not otherwise affect the Cedar Bend Humane Society. Barking Book Buddies Release and Waiver of Liability PLEASE READ CAREFULLY! This Release and Waiver of Liability executed on this ____________________day of __________________, 20________, by _____________________________ (your name) in favor of Cedar Bend Humane Society, a nonprofit corporation, and its directors officers, employees, and agents. The child desires to work as a volunteer for Cedar Bend Humane Society and engage in the activities related to being a Book Buddy for Cedar Bend Humane Society. The child understands that the Activities may include being in close contact with dogs (giving them treats and being exposed to loud noises such as barking). The Book Buddy hereby freely, voluntarily, executes this Release under the following terms: The child must follow all of the instructions given by staff and certified volunteers, keep fingers and body out of kennels at all times aside from when permitted to pet dogs. IN WITNESS WHEREOF, Book Buddy has executed this Release as of the day and year first above written. Book Buddy (child): ______________________________________________________________________ Witness (parent):_______________________________________________________________________ This program, Barking Book Buddies, was initiated by Maya Gabriele and Avanti Gulwadi as part of a school project for the ALPHA program. Cedar Bend Humane Society Address: 1166 West Airline Hwy, Waterloo, IA 50703 Phone: (319) 232­6887 www.CedarBendHumane.org