HSOY Summer Camp

ENROLLMENT

Guardian’s Information:

FULL NAME: ______Relationship to Child: ______

Phone Number: ______Alternate Phone Number: ______

Address: ______

Email Address: ______

Circle the session(s) you wish to enroll:
Session 1:
FUR FRIENDS
June 12th – 16th
Ages 8-9
Responsible Pet Ownership / Session 2:
Animal Ambassadors
June 19th – 23rd
Ages 9-10
Animal behavior, environment and pet population / Session 3:
Animal Explorers/Heroes
June 26th – 30th
Ages 10-11
Exploring veterinary science and animal careers. / Session 4:
What it means to BEHUMANE
July 10th- 14th
Ages 11-13
*Week-long video production project about animal welfare.
Child’s First Name
Child’s Last Name
Preferred Name for Name Tag
Date of Birth/Age
Gender
T-Shirt Size
Please specify if it is a youth or adult size.
Allergies?
Special Needs/Requests

Emergency Contact Information

Child’s FULL NAME

Emergency Contact Name: ______

Relationship to child: ______

Phone Number: ______Alternate Phone Number: ______

2nd Emergency Contact Name: ______

Relationship to child: ______

Phone Number: ______Alternate Phone Number: ______

INSURANCE PROVIDER: ______POLICY #: ______

Authorized Person/s for Pick-Up

*Names MUST be listed in order to pick up. Please include yourself.

First Name / Last Name / Relationship to Child

Agreement and Liability Waiver

As parent and legal guardian, I, ______(FULL NAME), understand that said child [______(CHILD’s FULL NAME)] will be participating in activities at the Humane Society of Yuma and in the course of such activities said child may have direct contact with domestic animals and other people.

I further understand that the behavior of domestic animals is sometimes unpredictable and that some domestic animals are capable of inflicting serious personal injury, as well as extensive property damage. Knowing the risks of handling domestic animals, on behalf of the minor and myself, I agree to assume those risks and to release, indemnify, and hold harmless Humane Society of Yuma and/or any of its Officers, Directors, Employees, Agents, Volunteers or Contractors for any and all personal injury and property damages resulting from said child's participation in activities.

I also understand that said child is to remain on Humane Society of Yuma property for the duration of the activities. If my child leaves the property during participation, with or without permission from a staff member, I release, indemnify, and hold harmless Humane Society of Yuma for any and all personal injury and property damages resulting from said child leaving Humane Society of Yuma property.

MEDICAL:I give Humane Society of Yuma authority to seek emergency medical treatment for said child. I know of no medical or other condition that would prevent said child from participation in activities at the Humane Society of Yuma. Furthermore, in the event of an accident or injury to my child, I authorize the Humane Society of Yuma to make whatever transportation, diagnosis and/or treatment arrangements as they, in their sole discretion, deem to be appropriate in the circumstances. I agree that my insurance or I personally will be liable for any costs incurred for the transportation, diagnosis and/or treatment of my child. I understand that the Humane Society of Yuma will make a reasonable effort to contact me at the phone number(s) listed below and to honor any other health care requests indicated in the Enrollment form “Special Needs/Requests” section but that the transportation, diagnosis and/or treatment of my child will proceed whether or not I can be contacted.

PHOTO/VIDEO/PRODUCTION RELEASE: I grant the right to photograph, video, reproduce, and use said child's artwork, written work, picture, silhouette, and other reproductions of physical likeness in connection with Humane Society of Yuma promotions and/or reports.

DRESS CODE: I understand that for the safety of my child, he or she is required to wear closed-toes shoes that have adequate traction (sneaker or athletic shoes). It is highly recommended that the children wear jeans or khakis to protect their legs and lightweight shirt or top. Children should dress appropriately for the activities scheduled.

BEHAVIOR: I understand that under no circumstances will physical violence inflicted on an animal, other participants, employees or volunteers will be tolerated and will result in immediate dismissal without refund. The Humane Society of Yuma staff will create a fun and safe environment for participants. In the event of destructive, physically and/or verbally, abusive or violent behavior, I understand that I will be informed privately and that the incident/s will be documented, I will receive a copy and the original will be kept on file at the Humane Society of Yuma. Your child will be dismissed and not allowed to participate in future classes.

REGISTRATION AND REFUNDS: I understand that refunds may only be provided with a two weeks’ notice of cancellation, prior to your scheduled attendance, minus the $50 non-refundable deposit. If the $50 non-refundable deposit was made, the remaining balance is due on the first day of the camp session. There will be no proration of fees for any days a child participant cannot attend.

PICK UP and DROP OFF PROCEDURE:A sign in/out area will be available when you arrive at camp. You must sign your full name on the attendance roster when bringing children to camp and when picking them up. Please print your child’s name legibly. Your child will only be released to the parent/guardian or other authorized individual listed on the Participant Information Form. Identification may be checked daily. While we know it can be inconvenient to show your ID every day, we appreciate your support in assisting our staff with keeping your children safe. We will not release a child without proper authorization. For the safety of your child, we will not release your child to anyone who appears under the influence of drugs and/or alcohol, but will assist in making other arrangements for transportation home. If your child has not arrived by the start of the camp day, we will assume he/she will not be attending camp, and we will begin our day without him/her.

Also, you are hereby informed that HSOY uses inmate labor and said inmates will be present at the shelter until approximately 11:30am. Therefore, you may not drop your child off prior to noon.

LATE PICK-UP POLICY: Please pick up your child on time each day. If an emergency arises and you are unable to reach the site before closing, call the staff to inform them of your progress and estimated arrival time. You will be charged $1 for each minute after 5:10 pm that you are late to pick up your child. These additional fees are due in full prior to signing your child up for subsequent camps or recreation department programming. If you will be late, please contact a staff member via the camp phone.

Please Note: Please understand that animal time during camp may be limited or varied depending on the day and the camp based on what animals we have at the time. Shelter animals are in an extremely stressful environment and we want to make sure we are providing the campers and animals with a safe and enriching experience free of harm and stress.

By signing below, I understand and agree to the policies and procedures of the Humane Society of Yuma’s Summer Camp Program.

GUARDIAN NAME: ______SIGNATURE:______DATE: ______

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