Payment of $100 total is due at the time of registration. We will manually process your credit card information below as soon as we receive this form.

In consideration of my child’s participation in Winter 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 Winter 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.