Youth Programs Waiver

Please complete this form and wavier for your child to attend Youth Programs at Animal Welfare Society.

Parent's/Guardian's Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Email*
Phone*
Preferred Contact Method*
- Phone
- Email
Emergency Contact (other than above Parent/Guardian)*
Please list Full Name, Relationship and Phone Number
Child's Name*
First Last
Child's Date of Birth*
MM slash DD slash YYYY
Child's Age
Child's Grade Level
Child's Preferred Name/Nickname
Child's Preferred Pronouns
Does child have any known allergies?*
- Yes
- No
Child is allergic to*
Special needs or medication
Unfortunately, passing of any medication, prescription or over the counter, cannot be accommodated by AWS staff or volunteers
Child's school, rec program, troop or organization*
Participation & Enrollment Waiver*
Thank you for enrolling your child in this Animal Welfare Society Humane Education program. In accordance with section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990, the Animal Welfare Society (AWS) invites you to identify any physical or mental disability or behavior that would preclude your child from fully participating in the program. We are committed to complying with the requirements of the Acts set forth above. In this regard, AWS, to extent required by law, will provide reasonable accommodations to participants who require them in order to participate in the program. Individuals with disabilities are not required to self-identify at any time. However, AWS is only required to provide reasonable accommodations for known disabilities. If your child needs a reasonable accommodation(s) in order to participate in our program, you must include that information with registration. AWS will make every effort to provide reasonable accommodation should your child have special needs, however, we are not able to provide one-on-one attention to your child. For the safety of and fairness to the group, if your child is unable to or refuses to fully participate in group activities, you will be called and asked to pick him/her up. The undersigned hereby release, waive, discharge, covenant not to sue and agree to indemnify and hold harmless AWS and all its officers, trustees, agents, employees, parents and volunteers (“releasees”), whether acting officially or otherwise, for any and all loss or damage and any claim or demands therefore on account of injury to the person or property arising out of or related to the AWS Humane Education programming, whether caused by the negligence of the releasees or otherwise. The undersigned has read this release and waiver of liability, assumption of risk and indemnity agreement, fully understand its terms, understand that they have given up substantial rights by signing it, and intend their signatures to be a complete and unconditional release of all liability to the greatest extent allowed by law. The undersigned agrees to permit the free use of my child/ward’s name and picture in any broadcast, telecast or other account of the event.
I agree