Critter Camp: Jun. 5-7 - Yellowstone Valley Animal Shelter

Critter Camp: June 5-7

Child's Name

Date of Birth

Gender

MaleFemale

Parent/Guardian's Name

Home Address

City

State

Zip/Postal Code

Phone

Emergency Contact's Name

Emergency Contact's Phone

Medical InformationList any known allergies and known medical conditions. Please note that camps are NOT suitable for children with allergens to pet dander and/or nuts.

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Preferred Hospital

Preferred Doctor

Insurance Information

Authorization for Pick-UpFor the safety of your child, we ask that you list the NAME, RELATION, & PHONE NUMBER for each person that can pick up your child from day camp. Any person on this list will not be allowed to pick up your child from camp, unless pre-approved by you.

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Emergency Authorization Waiver

As the parent/guardian of the child named above, I grant permission for YVAS staff to obtain emergency medical treatment for him/her/them. I agree to pay all expenses incurred due to an emergency involving my child.

Photography Waiver

I understand that when participating in YVAS's camps, my child may be photographed for print, video, or electronic imaging. As parent/guardian, I understand that the images may be used in promotional materials, news releases, and other published formats for YVAS. I acknowledge the images will be the sole property of YVAS.

Activities Waiver

I certify that I am familiar with the activities offered by YVAS's day camps and grant permission for my child to participate in these activities.

Cancellation Policy

I understand that cancellations made less than one week prior to the start of the program will not be refunded. Cancellations made greater than one week prior to the start of the camp session will be refunded, minus a 25% processing fee, for each registration. If a camp or program session is canceled by YVAS, all registration fees will be refunded in full. Registration fees for any YVAS camp or program are non-transferable.

Release, Consent, & Indemnification

The undersigned parent or guardian of the registered child ("Minor") hereby consents to the Minor participating in Critter Camp through Yellowstone Valley Animal Shelter, and all of its activities and programs, and in consideration thereof provides the Release, Consent, and Indemnification.

The undersigned, for himself or herself and on behalf of said Minor, does hereby absolutely and unconditionally release, indemnify, hold harmless and forever discharge Yellowstone Valley Animal Shelter, its employees, successors, assigns, and agents and each of them, from and against all claims, demands, obligations, and liabilities of every kind and nature whatsoever, including, without limitation, negligence, including the negligence of Yellowstone Valley Animal Shelter and its Agents, occurring during, directly or indirectly resulting from or arising out of the Minor’s participation in such Critter Camp.

As to matters covered hereby, the Release, Consent, and Indemnification shall pertain to all claims, demands, and rights which the undersigned Minor (and/or each of their heirs, successors, and assigns) has or may ever have against the parties released and indemnification hereby, or any of them, for any injuries, costs, or damages to the minor occurring directly or indirectly resulting from or arising out of the Minor’s participation in such Critter Camp whether such injuries, costs, or damages are known or unknown, foreseen or unforeseen, ascertainable or unascertainable, or suffered by the participant or any other person.

I consent to the above conditions and understand YVAS is not responsible for any injury or loss.

Parent/Guardian's E-SignatureBy "signing" this field, I agree to each of the statements above and indicate that the information provided is true and that I have read and understand the release form in its entirety.

Date

$ 150.00

Stripe Card Placeholder

Apply

It is the responsibility of the parents/guardians to notify Yellowstone Valley Animal Shelter at 406-294-7387 if changes occur that affect the information on this form.