Animal Resource Network, Inc.

P.O. Box 80376 Lansing, MI 48908-0376

(517) 853-8239

ANIMAL RESOURCE NETWORK, INC.

YOUTH VOLUNTEER APPLICATION AND RELEASE OF LIABILITY

Thank you for your interest in Animal Resource Network, Inc.(ARNI). ARNI is a non-profit Michigan corporation, which operates as an animal welfare organization. From time to time we offer volunteer opportunities to children. Youth volunteer paperwork consists of two components: 1) Application and 2) Release of Liability. If your child or children under 18 years of age, would like to volunteer, please read and complete both forms, sign and return to ARNI at the address above. We reserve the right to set different age requirements for different types of volunteer activities.

Youth Volunteer Application

Please print:

Today’s date: ____________________________________________________________

Your name: ______________________________________________________________

Please check one: ___ parent or ___ legal guardian (documentation required)

I give permission for the following child(ren) to participate in ARNI’s activities:

Child’s name: _______________________________________ Age: ________________

Child’s name: _______________________________________ Age: ________________

Child’s name: _______________________________________ Age: ________________

Child’s name: _______________________________________ Age: ________________

Address: ________________________________________________________________

Daytime phone: _________________________ Evening phone: ____________________

Cell phone: _____________________________

Emergency contact: _______________________________________________________

Name Phone Relationship

Describe the child(ren)’s experience with dogs: _________________________________

________________________________________________________________________

________________________________________________________________________

Is/are the child(ren) accustomed to large dogs? ___ yes ___no ____________________

________________________________________________________________________

________________________________________________________________________

Do you presently own or have you owned a dog? ___ yes ___ no What kind? _______

________________________________________________________________________

Describe the child(ren)’s experience with cats: __________________________________
________________________________________________________________________________________________________________________________________________

Do you presently own or have you owned a cat? ___ yes ___ no

Is there any information that would be helpful to us while your child(ren) is/are volunteering? ____________________________________________________________

Who is authorized to transport you child(ren)? __________________________________

It there anyone who is not authorized to transport you child(ren)?___________________

________________________________________________________________________

ANIMAL RESOURCE NETWORK

RELEASE OF LIABILITY

In consideration of ARNI offering this volunteer opportunity, I agree to the following, intending to be legally bound:

1. My child(ren), or child(ren) under my guardianship, _______________________ __________________________________________________________________

Child(ren)’s name(s)

has/have enough experience with (check all applicable items) ___ dogs and/or ___ cats and is/are mature enough to volunteer with ARNI and to participate in activities with ___ dogs and puppies of all sizes and/or ___cats and kittens.

2. Whenever my child(ren), or a child(ren) under my guardianship, participate(s) in ARNI’s activities, I hereby release, and agree to indemnify, defend and hold harmless ARNI, its directors, officers, employees, agents, and volunteers, and its and their heirs, successors, assigns, and personal representatives, from and against liability for any injuries, damages, liabilities, losses, judgments, costs expenses whatsoever (the “Losses”), that such child(ren) or any pet or other person might suffer or sustain. I acknowledge that there are risks that the child(ren) could be bitten, scratched, injured or frightened by the dogs/puppies and/or cats/kittens and/or other species and I assume such risks.

3. I am the parent and/or legal guardian of this/these child(ren) and I have accurately and truthfully completed this Permission and Release Form.

4. This Permission and Release Form is binding upon me, my spouse/partner, and my and his/her respective heirs, successors, assigns, executors, and personal representatives.

Dated: ______________________

PARENT/GUARDIAN ARNI REPRESENTATIVE

_____________________________ __________________________________

Signature Signature

_____________________________ __________________________________

Print name Print name

Approved May 10, 2004