P.A.L.S. Registration Form

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P.A.L.S. Registration

Please fill out the form below to register for a P.A.L.S. membership

P.A.L.S. Registration Form

We want your child’s P.A.L.S. Rescue Club experience to be rewarding and safe. P.A.L.S. is open to kids ages 10-13. For more information about the club, please contact Nicole Latosky at education@rescuevillage.org.

Participant's Name
Age
Date of Birth
Gender
Parent or Legal Guardian's Name
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone
Work Phone
Cell or Emergency Phone
Email
Peanut Allergies?
Other Allergies?
If so, are there medications you will provide?
T-Shirt Size
Payment Options
Membership Fee: $180, due at time of registration
Payment Method
- Will mail check
- Credit card (please fill out info below)
- Cash (drop-off only)
Name on Card
Card Number
Expiration
CVV
Billing Address (if different from registration address)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Questions for your child
This will help us make your child's experience more personal.
Favorite Animal
Favorite Color
Do you have pets at home? If so, what?
Animal Experience
Hobbies
WAIVER OF LIABILITY AND PERMISSION*
Accept waiver
In consideration of my child’s participation in the P.A.L.S. Rescue Club and other activities, the undersigned as parent/legal guardian of the minor identified below hereby agrees to hold harmless, release, waive, forever discharge and covenant not to sue the Geauga Humane Society (hereby hereafter referred to as GHS), its administrators, directors, agents, servants and employees, all of which are hereinafter referred to as “Releasees” from any and all liability to my child and myself along with our heirs, assigns and next of kin for any and all claims demands, losses or damages on account of injury, including death or damage to property, caused or alleged to be caused in whole or in part by the negligence of the Releasees or otherwise.

It is further agreed that the undersigned is fully aware of the nature and extent of the potential hazards and risks of children working with and /or near shelter animals and/or experiences that may arise, and agrees to assume those risks and to release, discharge, indemnify and hold harmless all of the Releasees mentioned above who (through negligence, carelessness or otherwise) might be liable to my child, myself or my heirs or assigns for damages. The undersigned releases, waives, forever discharges and covenants not to sue the Releasees for any and all loss or damage to personal property that may occur while participating in the P.A.L.S. Rescue Club.

The undersigned hereby grants permission to the GHS to use any photographs or video taken of the below-named minor, or artwork created by such minor, for use in its public relations efforts. The GHS has permission to include the minor’s name in materials that promote or publicize GHS services, programs and events, without compensation or notification. The undersigned understands that the minor will be participating in activities that may include media coverage, including, but not limited to, television, radio and newspaper.

The undersigned hereby grants permission to the GHS to utilize and authorize any medical emergency services it deems necessary for the below-named minor.

P.A.L.S. Registration Form

P.A.L.S. Registration

Please fill out the form below to register for a P.A.L.S. membership

P.A.L.S. Registration Form

Payment Options

Questions for your child