ROMP WAIVER AND RELEASE - APRIL 28, 2007

Name(s) ____________________________________________

____________________________________________ _____________________________________________

_____________________________________________

Address _____________________________________________________

Phone ______________________________________________________

Email ______________________________________________________

Dog names (s) ______________________________________________________

______________________________________________________

I understand that I am solely responsible for the health of my dog(s) and that they are up-to-date on vaccinations. Any medical issues that arise from our participation, is my responsibility.

I understand that I am solely responsible for any harm caused to or by my dog(s) and family members while my dog(s) is/are on the demised premise, Community Church of Syosset.

I hereby release and agree to hold harmless Community Church of Syosset, it’s owners, members, employees, agents and the International Doodle Owners Group, Inc. and their representatives, from any and all liability, claims, suits, or damage of any nature of kind, or for any liability, claims, suits, actions, loss, injury or damage which I, my family or my dog(s) may sustain or which may be caused in any way by my dog(s). I specifically, without limitation, agree to fully indemnify Syosset Community Church and the International Doodle Owners Group, Inc. and their representatives, for any and all such liability, claims, suits, actions, losses, injury or damage.

I certify that I have made full disclosure and have read, understand and accept the terms, conditions and statements in this agreement. Furthermore, I acknowledge that this agreement shall be effect and binding upon members of my family and or party.

Signature ________________________________________

Date ____________________________________