FFKC Camper Information - Humane Society of Jefferson County

Primary Guardian Information

Name(Required)

First Last

Email(Required)

Home Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Primary Phone(Required)

Secondary Phone

Would you like to add an additional guardian?(Required)

Yes

Additional Guardian Information

Name(Required)

First Last

Email(Required)

Home Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Primary Phone(Required)

Secondary Phone

Persons other than the parent/guardian who may deliver or pick up the child from HSJC:

First Name

Last Name

Phone

How many campers do you need to register?(Required)

Please enter a number from 1 to 5.

Camper's Information

Camper's Name(Required)

First Last

Nickname

Gender(Required)

Birthdate(Required)

T-Shirt size(Required)

Dietary Restrictions

Please list all known medical or behavioral conditions, including allergies

Second Camper's Information

Camper's Name(Required)

First Last

Nickname

Gender(Required)

Birthdate(Required)

T-Shirt size(Required)

Dietary Restrictions

Please list all known medical or behavioral conditions, including allergies

Third Camper's Information

Camper's Name(Required)

First Last

Nickname

Gender(Required)

Birthdate(Required)

T-Shirt size(Required)

Dietary Restrictions

Please list all known medical or behavioral conditions, including allergies

Fourth Camper's Information

Camper's Name(Required)

First Last

Nickname

Gender(Required)

Birthdate(Required)

T-Shirt size(Required)

Dietary Restrictions

Please list all known medical or behavioral conditions, including allergies

Fifth Camper's Information

Camper's Name(Required)

First Last

Nickname

Gender(Required)

Birthdate(Required)

T-Shirt size(Required)

Dietary Restrictions

Please list all known medical or behavioral conditions, including allergies

Consent and Liability Release for Humane Society of Jefferson County Furry Friends Kids Camp

Camper Full Name(s):(Required)

I, the undersigned parent or guardian of the above named child (“Minor”), hereby consents to the Minor participating in the Furry Friends Kids Camp of the Humane Society of Jefferson County, Inc., of Jefferson Wisconsin (the “Society”) and all of its activities and programs. The undersigned, for herself or himself and on behalf of said Minor, does hereby and unconditionally REALEASE, INDEMNIFY, HOLD HARMLESS and forever DISCHARGE the Society, its employees, directors, volunteers, successors, assigns, and agents and each of them, from and against any and all claims, demands, obligations, and liabilities of every nature and kind whatsoever, including, without limitation, negligence occurring during, directly or indirectly resulting from or arising out of the Minor’s participation in such Furry Friends Kids Camp. As to matters covered hereby, the CONSENT AND RELEASE shall extinguish all claims, demands, and rights which the undersigned or the Minor (and/or each of their heirs, successors, and assigns) has or may have against the parties released hereby, or any of them, for any injuries, costs or damages to the Minor occurring during, directly or indirectly resulting from or arising out of the Minor’s participation in such Furry Friends Kids Camp whether such injuries, costs or damages are known or unknown, foreseen or unforeseen, ascertainable or unascertainable.

Please check each box to indicate that you understand and agree to the following terms:(Required)

I, the undersigned, agrees that the Humane Society of Jefferson County, Inc. may photograph the Minor’s participation in the Furry Friends Kids Camp and hereby releases any such photographs to the Humane Society of Jefferson County, Inc. for its use in programs, publications, social media sites and purpose.

I, the undersigned, understand that the Society may, in its sole discretion, dismiss any Minor for inappropriate, disrespectful, or dangerous behavior at any time. In this event, I understand that I will not receive a refund of camp fees for unattended days. If the Minor breaks or damages any property as a result of their direct or indirect behavior, I hereby agree to pay for its repair or replacement.

I, the undersigned, understand that if the Minor requires one-on-one support, I am responsible for providing such. If I am unable to do so, this can result in dismissal from Furry Friends Kids Camp. In this event, I understand that I will not receive a refund of camp fees for unattended days.

I, the undersigned, acknowledge that I have been provided with adequate time to read this release and to obtain any advice that I might want or need. I have been offered the opportunity to negotiate the terms and conditions of this liability waiver and indemnification agreement and to bargain for the opportunity to participate in activities without signing this release, prior to signing it below. I have chosen, however, to accept the terms and conditions of this agreement as they are stated, without negotiation. I am signing this document voluntarily and intelligently.

Parent/Guardian's Full Name:(Required)

Entering your name here indicates that you understand and agree to the above terms.

Today's Date:(Required)

Comments

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Primary Guardian Information

Additional Guardian Information

Camper's Information

Second Camper's Information

Third Camper's Information

Fourth Camper's Information

Fifth Camper's Information

Consent and Liability Release for Humane Society of Jefferson County Furry Friends Kids Camp

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