Name(Required) First Last Email(Required) Location(Required) City State / Province / Region Consent(Required) I agree to the Release of Claims.I hereby certify I am aware of all the inherent dangers of handling dogs (mine and others) and of the basic safety rules for activities connected therewith. I understand that it is not the purpose of Therapy Dogs of Vermont to teach safety rules, obedience or handling of dogs and I’m familiar with Therapy Dog of Vermont Policies for handlers and dogs. I understand and guarantee that while I am participating in my three (3) visits prior to membership, I am responsible for any incident that might occur, and absolve and agree to hold harmless Therapy Dogs of Vermont from any liability. I also understand and agree that neither Therapy Dogs of Vermont or its officers, directors, members or agents may be held liable in any way for any occurrence in connection with said activities which may result in injury, death or damages to myself, family, or my dog. In consideration of being a member of this organization I hereby personally assume all risks which may befall me while I am engaged in this activity whether foreseen or unforeseen and further hold harmless the above mentioned entities and persons from any claim by me, or my family or any other party arising out of my participation in this activity. I further state that I am of lawful age and legally competent to sign this affirmation and release, which I understand. I have fully informed myself of the contents of this affirmation and release by reading it before I signed it. I assume my own responsibility of physical fitness and capability to perform under the normal requirements of this activity. I understand that TDV 3rd party liability insurance applies only when a currently registered therapy dog is participating in a TDV sponsored non-profit activity. I have read and agree to abide by TDV Policies during testing, during evaluations, and while volunteering. Additionally, I will indemnity/hold harmless Therapy Dogs of Vermont from any incident that occurs regarding this dog after testing.