I certify that to the best of my knowledge and information, I am physically able to perform volunteer services at Semper Fido, Inc. To the best of my knowledge I do not have any communicable disease.

I certify that I have not been convicted of any other offense graded by Title 2C of the New Jersey Statutes as a crime of the first, second, third or fourth degree, or an offense in any jurisdiction which, if committed in this State, would constitute such a crime, excluding any conviction that has been sealed or expunged.

I certify that I have not been convicted of any crime of violence or a crime against a person under the laws or under former laws of the State of New Jersey, the United States of one of its territories or possessions, another state, the District of Columbia, the Commonwealth of Puerto Rico, or a foreign nation.

I certify that I am not otherwise barred from serving as a volunteer with Semper Fido, Inc. or barred from working with the population that Semper Fido, Inc. serves, including but not limited to women and children, due to any restrictions imposes on me pursuant to any conviction under the laws, or former laws of the State of New Jersey, the United States or one its territories or possessions, another state, the District of Columbia, the Commonwealth of Puerto Rico, or a foreign nation.

I declare that I have never been found guilty or plead guilty to abuse of or cruelty toward any animal or person. No animal that I have ever owned has been declared by a court to be vicious. There is no court restraining order in effect against me.

I understand that I will NOT be considered to be an employee of Semper Fido Inc. or K9 Basics. It is my intention to volunteer my time to Semper Fido without expectation of compensation.

I understand that Semper Fido Inc. will not provide me with any health or accident insurance. In the event of an accident occurring while volunteering for Semper Fido Inc., I may receive appropriate emergency medical treatment but Semper Fido will not be liable for the cost of any medical care.

I agree to not make any claim or demand or to institute, press or in any way aid any claim, demand, action or causes of action or legal proceeding of any kind against Semper Fido or it's Board of Directors for, on account of or in any way growing out of any and all injury I may suffer while providing volunteer services or that result from my work as a volunteer at Semper Fido, Inc. that are not caused by or result from the negligence of any Semper Fido employee.

I agree to save and indemnify and keep harmless Semper Fido Inc. and their servants, officers, agents and employees against all liability, claims and judgments or demands for damages arising from losses or injuries of persons or property caused by my acts, and I agree to defend any and all suits that may be brought against Semper Fido Inc. or any of its officers or board members on account of any injury caused by my acts, and will make good to, and reimburse each of them for any expenditures that Semper Fido Inc. may make by reason of said injury.

I hereby consent to be included in promotional material developed and produced by Semper Fido Inc. I understand that my participation is voluntary and I can withdraw my consent at any time. Promotional material both for marketing and educational purposes, may include photographs and/or digital images, live and still action, and may be used in but not limited to, social media, videos, print media, pamphlets, brochures, newsletters, and the like. I hereby waive, release and forever discharge Semper Fido Inc., their officers and representatives from any and all claim, demands or causes of action arising from the use of my photograph, and/or digital image for the above purposes.