Apply for our Summer Camp!Please fill out the information below to apply for our 2020 Kids Summer Camp.Please contact education@rescuevillage.org with any questions. Camper's Name* First Last Date of Birth* MM slash DD slash YYYY Male / Female?*MaleFemaleParent / Guardian Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Email* Phone*Cell phone or Emergency NumberAlternative Contact In Case of Emergency* First Last Phone Number of Emergency Contact*Peanut Allergies?*NoYesAllergies of any other kind?*T-Shirt Size*Youth MediumYouth LargeAdult SmallAdult MediumAdult LargePlease mark your choice(s) in desired camp dates. Only 1 week allotted per child.* June 8-12 June 15-19 June 22-26 July 6-10 July 20-24 July 27-31 August 3-7 All camp sessions take place from 9:00 AM - 1:00 PM. The fee for all camps is $250 due at the time of registration.Of the above dates, please rank your order of preference starting with your first choice.*Payment InformationPayment of $250 total is due at the time of registration. We will manually process your credit card information below as soon as we receive this form.Credit Card #:Expiration Date:VCode:Billing Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Waiver of Liability and Permission FormIn consideration of my child’s participation in the Kids Camp 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 GHS Kids Camp. 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.Electronic Signature* First Last By filling in the name of the legal guardian of the minor participating in Winter Camp, you have read and understand the above waiver of liability and permission form.
