Insurance Animal Liability Waiver Form

Insurance Animal Liability Waiver Form

This Animal Liability Waiver and Release ("Waiver") is entered into by the undersigned Applicant/Insured and is intended to allocate risks related to the ownership, control, care, or custody of one or more animals identified below. Owner/Insured Name: Event or Location: Date of Event:

Applicant / Insured Information

Animal Identification

Provide details for each animal covered by this Waiver. If more than one animal, attach additional descriptions on company letterhead or an attached sheet and sign the attachment. Animal name: Species / Breed: Age:

Policy Details (if applicable)

Policy type (select all that apply):

Coverage Options

Select coverages and indicate limits where required. Selection does not itself constitute proof of insurance; refer to the policy declarations for actual operative coverage terms.

Exclusions & Acknowledgements

The undersigned acknowledges the following common exclusions and affirms understanding that claims arising from these circumstances may be denied or reduced in scope:

Beneficiary / Payee Designation

Designate any beneficiary or payee to receive policy proceeds or reimbursement in the event of covered loss requiring payment to Owner/Insured. If left blank, proceeds will be payable to the Owner/Insured on record.

Acknowledgement, Release and Indemnity

The undersigned Owner/Insured warrants that all information provided in this Waiver is true and complete to the best of their knowledge. The undersigned acknowledges that keeping, controlling, exhibiting, or transporting animals involves inherent risks including bodily injury, property damage, and death. By signing below the Owner/Insured hereby:

1. Assumes full responsibility for all risks associated with the animal(s) identified in this Waiver and for any person authorized by the Owner/Insured to handle such animal(s);
2. Releases, waives, discharges and covenants not to sue the insurer, policyholder (if different), event organizer, venue owner, employees, agents and volunteers (collectively "Released Parties") from any and all liability, claims, demands or causes of action arising out of injury, damage, loss, or death to persons or property resulting from the ownership or control of the animal(s), except to the extent caused by the gross negligence or intentional misconduct of the Released Parties;
3. Agrees to defend, indemnify, and hold harmless the Released Parties from and against any and all claims, judgments, losses, expenses, attorney fees, and costs arising out of bodily injury, property damage, or other loss caused by the animal(s), including third-party claims and costs of defense.

The undersigned further represents that the animal(s) are current on all legally required vaccinations and that truthfully disclosed history of aggression, bite incidents, and relevant medical conditions has been provided above. The undersigned understands that the insurer or Released Parties may deny coverage or payment for claims arising from material misrepresentations or nondisclosure.

Incident Reporting (if applicable)

In the event of injury, loss, or claim, promptly report to the insurer and the event organizer/venue. Provide the following preliminary incident information:

Certification

I certify, under penalty of perjury, that the foregoing information is true and correct to the best of my knowledge. I have authority to execute this Waiver on behalf of the Owner/Insured named herein. I acknowledge that this Waiver affects my legal rights and that I am signing freely and voluntarily.

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