Leo "The Love Nug" Waiver

Student/Client Name

First Name Last Name

Parent/Guardian Name

First Name Last Name

Email

example@example.com

CONSENT AND RELEASE OF LIABILITY FOR INTERACTION

WITH LEO “THE LOVE NUG”

Leo “The Love Nug” is a pot belly pig who spreads love and smiles. He loves people and attention. It is my intent to share Leo with people to improve their well being and bring happiness and joy to others. Animals can be a vital part of learning and therapeutic team, so I want to make sure you are comfortable with Leo’s presence in your (or your child’s) sessions. Because he is an animal, and not a human, I am responsible for his welfare. His behavior cannot always be predictable, so it is important to discuss in advance the rules needed to insure Leo’s and your safety and health, and try to create the safest situation possible.

While I have listed some rules and potential risks below, we cannot foresee all potential problems that may occur.

RULES:

Animals have individual rights, just as each student/client has rights. Therefore, Leo is allowed to determine if and when he participates with others. He will never be forced to participate in any activity.
Leo should always be treated gently. He should never be hit, have his tail or any other parts pulled, be carried or treated in any other way that is uncomfortable to him.
Leo will always have me present in any situation.
If Leo becomes irritated, scared, or in any way acts in a negative manner, I will put him in a safe place. No other person should touch him at these times.
Leo can only be carried by his owner and trainer.
Because of the unpredictability of animals in unfamiliar situations, students/clients may not bring their own animals to be involved in any session.

RISKS:

Animals have their own natural defenses. While I will do everything possible to prevent any injury, it is possible that someone may get scratched or bitten.
Loud noises and sudden actions may startle Leo. His reactions may vary, and include (but are not limited to) attempting to run, jump, flail his head, nip, and squeal.
Leo is highly motivated by food, so it is essential that any food or treats be kept out of reach unless we are using them as motivation or reward.
While Leo is a “hypoallergenic” pet (as he has hair and not fur), there may still be a risk for allergic reaction. Please let me know if you typically have allergies to animals.

Leo is currently in training; meaning he is still learning some skills. During the training process, and even once he is certified as an emotional support pet, you may opt to not participate in the group activities or have him be a part of your healing session.

With your submission of this form, you are stating your acceptance of these rules and risks and agree to accept full liability in the event that you or your child is harmed by interacting with Leo in any way during the course of the event or session. Additionally, you accept full liability if you or your child is harmed in any way as a result of being on the property of 4732 Muir Ave SD, CA 92107 or at any other location while in the presence of Julie Johnston and Leo. You are releasing Julie Johnston, Mindful Mobile Learning & Healing, and any organization or facility we may be presenting at from any liability should any injury occur as part of your participation.