PAPILLON RESCUE OF THE NORTH EAST (PRONE)
(once completed, save a copy to a place you can remember, like
your desktop) then email it to: [email protected]
Tips:
REPRESENTATIVE/VOLUNTEER AGREEMENT
WAIVER OF LIABILITY RELEASE FORM
POLICIES AND PROCEDURES
Thank you for your interest in joining our PRONE rescue family as a representative/volunteer!
Waiver and Release
1. I, the Representative/Volunteer, release and forever discharge and hold harmless Papillon Rescue Of
the North East (PRONE), a nonprofit 501(c)(3) corporation, from any and all liability, claims, and
demands of whatever kind or nature, either in law or in equity, which arise or may hereafter arise from
the services I provide to PRONE.. I understand and acknowledge that this Release discharges PRONE
from any liability or claim that I may have against PRONE with respect to bodily injury, personal injury,
illness, death, or property damage that may result from the services I provide to PRONE or occurring
while I am providing volunteer services.
2. Insurance: Further I understand that PRONE does not assume any responsibility for or obligation to
provide me with financial or other assistance, including but not limited to medical, health or disability
benefits or insurance of any nature in the event of my injury, illness, death or damage to my property.
I expressly waive any such claim for compensation or liability on the part of PRONE beyond what may
be offered freely by PRONE in the event of such injury or medical expenses incurred by me.
3. Medical Treatment: I hereby Release and forever discharge PRONE from any claim whatsoever which
arises or may hereafter arise on account of any first-aid treatment or other medical services rendered
in connection with an emergency during my tenure as a volunteer with PRONE.
PRONE | Kelly Arsenault, President | PO Box 939, Pelham, NH 030766 | www.pronepups.org [email protected]
2012
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PAPILLON RESCUE OF THE NORTH EAST (PRONE)
4. Assumption of Risk: I understand that the services I provide to PRONE may include activities that may
be hazardous to me including, but not limited to the handling, fostering, and/ or transporting of
animals. As a volunteer, I hereby expressly assume the risk of injury or harm from these activities and
release PRONE from all liability for injury, illness, death or property damage resulting from the services
I provide as a volunteer or occurring while I am providing Volunteer services.
5. Photographic Release: I grant and convey to PRONE all right, title, and interest in any and all
photographs, images, video or audio recordings of me or my likeness or voice made by PRONE in
connection with my providing volunteer services to PRONE.
6. Other: As a volunteer, I expressly agree that this Release is intended to be as broad and inclusive as
permitted by the laws of the State of New Hampshire and that this Release shall be governed by and
interpreted in accordance with the laws of the State of New Hampshire. I agree that in the event that
any clause or provision of this Release is deemed invalid, the enforceability of the remaining provisions
of this Release shall not be affected.
PRONE | Kelly Arsenault, President | PO Box 939, Pelham, NH 030766 | www.pronepups.org [email protected]
2012
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PAPILLON RESCUE OF THE NORTH EAST (PRONE)
Tell Us about Yourself and Your Home
If you have a significant other, does that person approve of your involvement with our organization?
 Yes
 No
Do you have children at home?  Yes
 No
If yes, their ages __________________________________________________________________________
Do you support spay and neuter contracts?  Yes
 No
Please list all pets you currently have.
Breed
Sex
Age
Spayed/Neutered?
Length of Ownership
If applicable, please list the following information about any pets that you had in the past 5 years that are no
longer with you.
Breed
Name
Are you a member of or do you support any other rescue organizations?  Yes
Reason
 No
PRONE | Kelly Arsenault, President | PO Box 939, Pelham, NH 030766 | www.pronepups.org [email protected]
2012
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PAPILLON RESCUE OF THE NORTH EAST (PRONE)
If yes, please list: _______________________________________________________________________
Have you read PRONE’s rescue policies listed below on Page 5?  Yes
 No
Do you have any questions? __________________________________________________________________
Do you have any suggestions? ________________________________________________________________
In what areas can you help PRONE? Please check all that applies.
 Transport
 Shelter Pickups
 Fundraising
 Solicit funds
 Distribute information
 Newsletters
 Home visits
 Make items for sale
 Administrative duties
 Good with computers and software
 Graphic or web design
Do you have special skills or interests? (For example, vet, vet tech, animal therapy, trainer, nutrition, holistic
remedies, lawyer, computer programmer, photographer, writer, etc.)
__________________________________
Can you provide a foster home for one of our rescues? Please check all that applies.
 Emergency only
 Special needs
 Special needs
Do you want a foster application sent to you?  Yes
 Short-term
 Long term
 No
Volunteer Responsibilities
During all volunteer activities, I understand that I am expected to abide by the following statements, and that
by signing this agreement and waiver form, I acknowledge that I have read and understood this form.
PRONE | Kelly Arsenault, President | PO Box 939, Pelham, NH 030766 | www.pronepups.org [email protected]
2012
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PAPILLON RESCUE OF THE NORTH EAST (PRONE)

I will treat all animals and other volunteers with respect, and I will work as a team member with all
volunteers. I understand that the rescue of animals is PRONE’s mission and highest goal and that all
activities must be done collaboratively and with consideration of others for this mission to be
accomplished.

I am aware that as a volunteer of PRONE, I am acting as a representative of the organization and agree
to act responsibly at all times by maintaining a professional demeanor. I understand that it is
important to protect the reputation of PRONE at all times, and that even though sometimes people
can be grumpy and rude, I will always do my best to be understanding, helpful, and use good customer
service.

I agree to be supervised as appropriate by PRONE personnel and will report any problems that arise
directly to the proper PRONE representative. I will take any complaint or concern directly to a Board
of Director or appropriate Coordinator, not to any other volunteer or member of the public.

I understand that I am only allowed to participate in PRONE approved volunteer activities, as directed
by the Volunteer Coordinator, Events Coordinator, or Board of Directors. Any additional volunteer
activity that I wish to perform on behalf of PRONE must be pre-approved by the PRONE Board of
Directors prior to participating.

I agree to always follow through with any responsibility that I have committed to and to arrive on time
to any event or activity I have agreed to assist with. If for some reason I am unable to attend an
activity I have said I will be at, or if I am going to be late, I promise to make every effort to contact the
Volunteer Coordinator, Event Coordinator, or another PRONE Director.

I will abide by all PRONE rules, policies, procedures, or other guidelines.

I agree that any animal rescued by PRONE is owned solely by and is the property of PRONE, and as a
volunteer of this organization, I will not withhold, sell, or give away any animal entrusted to me by the
organization. I will follow all rules regarding animal release and adoption, and will not break them for
any reason.

I understand that I will not be reimbursed for any expense that I incur while volunteering for PRONE,
unless it has been pre-approved by the PRONE Treasurer or Board of Directors.

I understand that I will not be compensated for any of my services to PRONE.
PRONE | Kelly Arsenault, President | PO Box 939, Pelham, NH 030766 | www.pronepups.org [email protected]
2012
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PAPILLON RESCUE OF THE NORTH EAST (PRONE)

I understand that I am responsible for my own insurance coverage in the event of a personal injury or
illness as a result of my services to PRONE. PRONE does not provide any benefits traditionally
associated with employment.

I understand the possibility of risk of transferring disease-causing microorganisms during animal
handling activities from PRONE animals to myself and to my personal animals or vice versa (examples:
distemper, giardia toxoplasmosis, and other parasitic or fungal conditions such as ringworm). I agree
to take all precautions to avoid such transfer, I agree to the importance of having myself and my pets
up to date on all current vaccinations, and that I should be in particular up to date on my tetanus
vaccination and covered by a health insurance plan. I understand that PRONE will not be responsible
to pay for any vaccination, for my pet or myself.

I understand that although PRONE will make every attempt to ensure the safety of their volunteers
and animals, rescue animals are by nature unpredictable in their behavior. Therefore, I assume the
risks of being bitten, scratched, injured, or frightened by cats, kittens, dogs, and puppies in connection
with my volunteer work for PRONE. Neither PRONE, or any of its Directors, volunteers, fosters, or
other affiliates are liable to me for any injuries, damages, liabilities, losses, judgments, costs, damage
to property or expenses whatsoever that I might suffer or sustain in connection with the performance
of my volunteer activities for PRONE. I will indemnify, defend, and hold the PRONE Directors,
volunteers, fosters, or other affiliates harmless from and against any claims, lawsuits, injuries,
damages, losses, costs, or expenses whatsoever sustained by any foster animal or any person in
connection with my intentional misconduct or grossly negligent performance of volunteer activities for
the PRONE or my breach of the PRONE’s rules, regulations, policies, and programs.

I understand that if I fail to abide by the terms of this Agreement & Waiver form, or am otherwise
unable to meet the requirements of the volunteer program, which are subject to change by PRONE
Directors at any time, I understand that I can be terminated from the program. I also understand that I
may, at any time, be removed from my position as a volunteer at the discretion of the PRONE Board of
Directors.
This release and waiver of Liability executed on _____________________________________________(date)
by _____________________________________________ (print name of Representative/Volunteer) releases
Papillon Rescue of The North East (PRONE), a 501(c)(3) nonprofit corporation, formed under the laws of the
state of New Hampshire and each of its directors, officers, and agents. The volunteer desires to provide
volunteer services for PRONE and engage in activities related to serving as a volunteer for the activities of
PRONE.
PRONE | Kelly Arsenault, President | PO Box 939, Pelham, NH 030766 | www.pronepups.org [email protected]
2012
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PAPILLON RESCUE OF THE NORTH EAST (PRONE)
PRONE | Kelly Arsenault, President | PO Box 939, Pelham, NH 030766 | www.pronepups.org [email protected]
2012
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PAPILLON RESCUE OF THE NORTH EAST (PRONE)
By signing below, I express my understanding and intent to enter into this Release and Waiver of Liability
willingly and voluntarily.
__________________________________________________________________________________________
Signature of Representative/Volunteer
Print Name
__________________________________________________________________________________________
Street Address
__________________________________________________________________________________________
City, State, Zip Code
__________________________________________________________________________________________
Email Address
__________________________________________________________________________________________
Home Phone Number
Work Phone Number
Cell Phone Number
__________________________________________________________________________________________
Driver’s License and State
__________________________________________________________________________________________
Occupation
Employer
PRONE POLICY AND PROCEDURES
1.
At the present time, PRONE will only accept purebred Papillons or Pomeranians. All dogs accepted
must be approved by the adoption committee. A picture of the dog must be sent to the committee, so
that the dog breed may be identified before approval. If this process is not followed, PRONE reserves
the right to disapprove a specific dog. PRONE will only accept those dogs that we can care for
financially, and monthly reports and updated pictures will be submitted to the adoption committee.
PRONE | Kelly Arsenault, President | PO Box 939, Pelham, NH 030766 | www.pronepups.org [email protected]
2012
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PAPILLON RESCUE OF THE NORTH EAST (PRONE)
2. The Board of Directors of PRONE shall consist of five members. Members may be replaced if there is a
consensus that individual jobs are not being done or they are no longer on the PRONE list of active
members.
3. The Board of Directors shall meet once a month on a day specified by the President. Meetings will be
held via conference call and a majority of members of the Board will be needed for any matters that
require voting. All members of the Board will have equal voting privileges.
4. Vetting of the dog should be approved prior to foster acceptance. In the case of emergency, you may
immediately take the dog for veterinary care and later report it to the board. The dog must be tested
and kept on heartworm prevention meds. We will neuter, provide vaccinations, and a dental if
needed. Rabies injections must be kept current.
5. Any approval for adoption must be given after review by the Adoption Committee. Our purpose is to
provide each dog a home and loving care for the rest of its life. If in the event an adoptive home wants
to return a dog, it is our responsibility to bring the dog back into our care until another placement is
made. THERE WILL BE NO EXCEPTIONS TO THIS.
6. All members will work with the Fundraising Committee.
PRONE | Kelly Arsenault, President | PO Box 939, Pelham, NH 030766 | www.pronepups.org [email protected]
2012
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