Summer Camp Registration Form 2021

Summer Camp Registration is now open for ages 9-12.
This year, we are providing themed-camp weeks by animal grouping.
Campers will enjoy their experience by participating in the following:

Watching animal demonstrations by visiting guest speakers

Making animal treats

Helping promote shelter animal adoptions

Participating in animal chores

Making shelter animal toys and blankets

We will be offering both in-person as well as virtual options for attendance.*
*Virtual options will be provided with activity boxes

Camp runs Tuesdays-Thursdays from 9am-12pm(noon) located at Rescue Village*

(*Barn Camp will be at our offsite-barn location)

In-person camps will be limited, so register below!

For additional questions or concerns, please contact

Nicole Latosky

Humane Education Coordinator

education@rescuevillage.org

Camper Information

Name of Camper

Birthdate of Camp (mm/dd/year)

Gender of Camper (drop down)

Primary Phone

Any allergies?

T-shirt Size? (drop down)

Contact Info

First Name

Last Name

Country

Address 1

Address 2

Postal Code

City

State

Email Address

Yes, I would like to receive email communications.Yes, I would like to receive email communications.

Waiver

WaiverWAIVER OF LIABLITY AND PERMISSION FORM In consideration of my child’s participation in Summer 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 Summer 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.

Waiver Authorization

Payment

Credit CardACHPayPalOneClick

Name On Card

Card Number

Card Type

Expiration Month

Expiration Year

CVV Code

Account Number

Routing Number

Name On Account

Account TypeCheckingSavings

Billing Address 1

Billing Address 2

Billing Postal Code

Billing City

Billing State

Billing Country