Loading...

PIEDMONT FARM ANIMAL REFUGE

RELEASE AND WAIVER OF LIABILITY

This RELEASE AND WAIVER OF LIABILITY (this “Release”) is made by the undersigned (“I” or “me”) in favor of Piedmont Farm Animal Refuge, a North Carolina nonprofit corporation, and its officers, directors, employees, volunteers, and agents (collectively, the “Refuge”). I desire to visit and/or volunteer for the Refuge and to engage in activities in connection with my visit or volunteer work (collectively, the “Activities”).

In exchange for being allowed to visit and/or volunteer at the Refuge and to engage in the Activities, I hereby freely, voluntarily, and without duress execute this Release and agree to the following terms:

1. Compliance with Rules & Expectations. I have received and read the Refuge’s Rules & Expectations for visitors and volunteers, a copy of which is attached. I agree to comply with the Rules & Expectations and all other applicable policies and procedures, training, and safety rules of the Refuge, and will follow the instructions of Refuge personnel while at the Refuge and/or engaging in the Activities.

2. Fitness to Participate. I confirm that I am in good health and physical condition and do not have any medical or other conditions that would impair my ability to participate in the Activities. If at any time I believe conditions to be unsafe, or that I am no longer in proper health or physical condition to participate in the Activities, I will immediately discontinue further participation in the Activities.

3. Assumption of Risk. I am aware and understand that the Activities may be inherently dangerous and may expose me to a variety of foreseen and unforeseen hazards and risks, including but not limited to risks associated with contact with animals and potential exposure to zoonotic diseases, contact with plant and insect allergens (including but not limited to poison ivy, fire ants, etc.), construction tasks, heavy lifting, exposure to heights, uneven terrain and weather conditions, and transportation to and from the work sites. I acknowledge that I am voluntarily participating in the Activities and have considered those risks. I hereby expressly and specifically assume such risks, including any and all risk of injury, harm, or loss that I may incur as a result of my participation in the Activities.

4. Medical Treatment. I hereby give consent and authority to the Refuge to obtain medical treatment on my behalf if I am injured or require medical attention during my participation in the Activities. I understand and agree that I am solely responsible for all costs related to such medical treatment, medical transportation, and/or evacuation. I hereby release, forever discharge, and hold harmless the Refuge from any claim whatsoever in connection with such treatment or other medical services.

5. Release and Waiver. I hereby fully and forever release and discharge the Refuge from, and expressly waive, any and all liability, claims, and demands of whatever kind or nature, either in law or in equity, that may arise from my participation in the Activities. I agree not to make or bring any such claim or demand against the Refuge, and fully and forever release and discharge the Refuge from liability under such claims or demands.

I UNDERSTAND THAT THIS RELEASE DISCHARGES THE REFUGE FROM ANY LIABILITY OR CLAIM THAT I MAY HAVE AGAINST THE REFUGE WITH RESPECT TO ANY BODILY INJURY, PERSONAL INJURY, ILLNESS, DEATH, PROPERTY DAMAGE, OR PROPERTY LOSS THAT MAY RESULT FROM THE ACTIVITIES, WHETHER CAUSED BY THE NEGLIGENCE OF THE REFUGE OR OTHERWISE.

6. Insurance. I UNDERSTAND THAT THE REFUGE DOES NOT ASSUME ANY RESPONSIBILITY FOR OR OBLIGATION TO PROVIDE FINANCIAL ASSISTANCE OR OTHER ASSISTANCE, INCLUDING BUT NOT LIMITED TO MEDICAL, HEALTH, OR DISABILITY INSURANCE OF ANY NATURE IN THE EVENT OF MY INJURY, ILLNESS, OR DEATH, OR DAMAGE TO OR LOSS OF MY PROPERTY. I also understand that the Refuge does not provide workers’ compensation insurance for volunteers. I expressly waive any claim for compensation or liability on the part of the Refuge in the event of any injury or medical expense.

7. Indemnification. I hereby agree to indemnify, defend, and hold harmless the Refuge from any and all liability, losses, damages, judgments, or expenses, including attorneys’ fees, that it may incur or sustain as a result of my negligence, recklessness, or willful misconduct in connection with my participation in the Activities, arising out of any third-party claim.

8. Photographic Release. I understand and agree that during the Activities, I may be photographed and/or videotaped by the Refuge for internal and/or promotional use. I hereby grant and convey to the Refuge all right, title, and interest, including but not limited to, any royalties, proceeds, or other benefits, in any and all such photographs or recordings, and consent to the Refuge’s use of my name, image, likeness, and voice in perpetuity, in any medium or format, for internal and/or promotional use without further compensation or permission.

9. Miscellaneous. I hereby agree that this Release represents the full understanding between the Refuge and me and supersedes all other prior agreements, understandings, representations, and warranties, both written and oral, between us, with respect to the subject matter hereof. If any term or provision of this Release shall be held to be invalid by any court of competent jurisdiction, that term or provision shall be deemed modified so as to be valid and enforceable to the full extent permitted. The invalidity of any such term or provision shall not otherwise affect the validity or enforceability of the remaining terms and provisions. This Release is binding on and inures to the benefit of the Refuge and me and our respective heirs, executors, administrators, legal representatives, successors, and permitted assigns. Section headings are for convenience of reference only and shall not define, modify, expand, or limit any of the terms of this Release.

10. Governing Law. I hereby agree that this Release is intended to be as broad and inclusive as permitted, and that this Release shall be governed by and interpreted in accordance with the laws of the State of North Carolina, without reference to any choice of law doctrine.

BY SIGNING, I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTOOD ALL OF THE TERMS OF THIS RELEASE AND THAT I AM VOLUNTARILY GIVING UP SUBSTANTIAL LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE THE REFUGE.

RULES & EXPECTATIONS

1. All visitors and volunteers are expected to follow all rules, policies, procedures, and instructions as dictated by both this document and by Piedmont Farm Animal Refuge’s Staff and Volunteer Tour Guides and Leaders.

2. Possession or use of alcoholic beverages or illegal drugs on Refuge's property and/or participating in Refuge-related activities while under the influence of drugs or alcohol is prohibited.

3. Verbal, physical, or visual harassment of another participant, staff member or volunteer is prohibited.

4. Volunteers and visitors must use special care when in the presence of our animal residents. All verbal and/or written directions from Staff and/or Volunteer Leaders must be carefully followed.

5. No form of abusive behavior towards our animal residents is permitted.

6. No explosives, firearms, weapons, or other dangerous items may be brought to the Refuge.

7. Our sanctuary is 100% vegan out of respect for our rescued animals and in accordance with our organization’s mission. No animal products may be brought to or consumed on the Refuge’s property.

8. For Volunteers:

  • Volunteers are expected to arrive for their shifts on time and complete all work related to their shifts.
  • If a volunteer is unable to make their shift, they should contact the appropriate Staff and/or Volunteer Leaders as soon as possible.
  • Food, structures, or any other item that any animal has access to must be pre-approved by a Staff member before being given to that animal. Animals can be injured or die if they receive unauthorized items.
  • Work areas should be left cleaner than they are found. Dishes, buckets, and other items should be put away in the appropriate locations. Volunteers should contribute to keeping our sanctuary a clean and tidy place for our rescues and the people who work to care for them.
  • Volunteers will take particular care in opening doors and gates so that animals stay in their designated living areas at all times. If possible, gates should be climbed over instead of unlatched.
  • Additional visits outside of a volunteer shift must be pre-approved by the Animal Care Director.

Today's date: November 17, 2024

First Participant's Name

First Name*

Last Name*
First Participant's Age Acknowledgment*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Information

Any allergies, medications, or other information needed in an emergency:
How did you hear about us?*

If you chose "Other" in the previous question, please specify.
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information

Any allergies, medications, or other information needed in an emergency:
How did you hear about us?*

If you chose "Other" in the previous question, please specify.
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information

Any allergies, medications, or other information needed in an emergency:
How did you hear about us?*

If you chose "Other" in the previous question, please specify.
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information

Any allergies, medications, or other information needed in an emergency:
How did you hear about us?*

If you chose "Other" in the previous question, please specify.
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information

Any allergies, medications, or other information needed in an emergency:
How did you hear about us?*

If you chose "Other" in the previous question, please specify.
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information

Any allergies, medications, or other information needed in an emergency:
How did you hear about us?*

If you chose "Other" in the previous question, please specify.
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information

Any allergies, medications, or other information needed in an emergency:
How did you hear about us?*

If you chose "Other" in the previous question, please specify.
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information

Any allergies, medications, or other information needed in an emergency:
How did you hear about us?*

If you chose "Other" in the previous question, please specify.
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information

Any allergies, medications, or other information needed in an emergency:
How did you hear about us?*

If you chose "Other" in the previous question, please specify.
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information

Any allergies, medications, or other information needed in an emergency:
How did you hear about us?*

If you chose "Other" in the previous question, please specify.
Parent or Guardian's Email Address

Email
Check to receive information, news, and discounts by e-mail.
Your signed waiver will be sent to the email address provided here and is available for download for three days via URL attachment.
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*

Emergency Contact's Relation to Participant
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*

I am the parent or legal guardian of the minor named above. I have the legal right to consent to and, by signing below, I hereby consent in all respects to the terms of this Release. I authorize the Refuge to obtain medical treatment for such minor and release it from liability in accordance with Section 2 of this Release.



By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Relationship*

Phone*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information

Any allergies, medications, or other information needed in an emergency:
How did you hear about us?*

If you chose "Other" in the previous question, please specify.
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!