Pilot/Aircraft Liability Waiver

= Ground Crew Profile Liability Waiver

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Check One: ( ) Initial Application<= span style=3D'mso-spacerun:yes'> = ( ) Updating Information

Attention: By submitt= ing this form, you accept responsibility for ensuring you are in compliance with all State & Federal Driving Regulations including but not limited to required licensing, health, and car registration and insurance. A copy of your Car Insurance Card = must be on file with Flying Paws. = Please sign the second page and return all documentation to Flying Paws as instruc= ted at the end of this document. = Thank you for being a Flying Paws volunteer.

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Name: _______________________________________ Phone= #1 _____________

Street Address: ____________________________________ &= nbsp; Fax: _____________

City, State, Zip: ____________________________________= = Cell Phone: ___________

= &nb= sp; ____________________________________= Email: __________________

Emergency Contact: _________________________________ Phone Number: _________

&nbs= p; &= nbsp; Relation: ______________________________

Availability: (Circle One): Weekday<= span style=3D'mso-spacerun:yes'> Weekends

Distance Willing To Drive: (Circle the Greatest) Less = than 100,

101-200, G= reater than 200 miles

Restrictions: (Circle) unpaved road, no night, no emergency

&= nbsp; &nbs= p; Other: ___________________________________

CAR#1 = &nb= sp; = &= nbsp; Car#2

State Car License: _______________________ State Car License: _________________________

License Number: __________________________ License Number: ___________________________

Type/Model: ____________________ &= nbsp; Type/Model: ______________________<= /p>

Color: ________________________________ = Color: ___________________________________

Kennel Size: ___________________________ = Kennel Size: ______________________________

Transport Animal:&nbs= p; Dog, Cat, and Other = ; &= nbsp; Transport Animal: Dog, Cat, and Other

Additional Information: ________________________________________________________________

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Liability Waiver for G= round Crew Volunteers

Flying Paws is= an all volunteer organization. Flyin= g Paws ground crews voluntarily provide transportation in privately owned or rente= d cars or fostering for special needs rescue animals. Flying Paws does not financially reimburse the ground crews for any expenses for these activities. Ground crews provide help with promotions, educational programs, foster care, ground transport and

emergency grou= nd transportation for veterinary care of the animals in transit. No personal expenses are reimburse= d.

I, the undersi= gned Flying Paws volunteer, agree to waive and do waive and release Flying Paws,= its officers, directors and other volunteers from any and all claims including,= but not limited to liability for negligence, any personal injury or property da= mage that might be suffered, and any wrongful death actions which an estate migh= t bring, arising out of injury during any Flying Paws transport, foster or activity.= It is understood and acknowledged that my signing this Waiver of Liability is bound and effective for any and all Flying Paws transports, foster or other activities. I further underst= and that the driver of any Flying Paws ground transport has the final deci= sion concerning the cancellation of the transport due to weather, mechanical problems or for any reason whatsoever, if in their judgment the transport c= an not be completed in a safe manner. Flying Paws requires that the driver of any ground transport hold the correct drivers license, have current insurance and meet all of the state a= nd Federal regulations required to operate a vehicle. The driver has the option to have = another person ride with them provided that they have signed the Liability Waiver a= nd it is on file with Flying Paws. The providing of any transport is totally voluntary and if there is any reason whatsoever that the ground transport can not be completed in a safe manner:= the transport is to be cancelled or postponed.= I understand that the animals must be transported in appropriate ken= nels and must be accompanied by all required paperwork. Kennels are provided by the driver= due to the different configurations of cars and remain the property of the driv= er. Should an animal be transported ou= tside of a kennel, it is the driver who will determine whether the transport will happen. Transport safety dete= rmines any and all decisions by the driver.

Signature: ___= _________________________________________________ &= nbsp; Date: ______________

Printed Name: _________________________________________________

Please email completed form and a scan of your insuran= ce policy to groundcrew@att.net, fax= to 928-636-7151 or mail these documents to Flying Paws P.O. Box 4798 Chino Valley, AZ<= span style=3D'mso-spacerun:yes'> 86323

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