2019 Humane Hands Registration Form

1. Please provide the Parent/Guardian name, address, phone number and email below. (You will be asked to enter your child's information below.)

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Name:

 

 

   

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City/State/ZIP:

 

    

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What's this?

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(Maximum response 255 chars, approx. 5 rows of text)

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Question - Required - Child's Date of Birth:




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Question - Required - T-Shirt Size (all sizes are adult sizes):





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Question - Required - How did you hear about Humane Hands?
Please make between 1 and 5 selections from the choices below.

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Humane Hands Wavier & Release of Liability

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The undersigned is the parent/legal guardian of child(ren) named below.  I understand that said child will be participating in activities at the Nebraska Humane Society and in the course of such activities said child may have direct contact with domestic animals.

 

I further understand that the behavior of domestic animals is sometimes unpredictable and that some domestic animals are capable of inflicting serious personal injury, as well as extensive property damage. Knowing the risks of handling domestic animals, on behalf of the minor and myself, I agree to assume those risks and to release, indemnify, and hold harmless the Nebraska Humane Society and/or any of its Officers, Directors, Employees, Agents, or Contractors for any and all personal injury and property damages resulting from said child's participation in activities.

 

I also understand that said child is to remain on the Nebraska Humane Society property for the duration of the activities. If my child leaves the property during participation, with or without permission from a staff member, I release, indemnify, and hold harmless the Nebraska Humane Society for any and all personal injury and property damages resulting from said child leaving the Nebraska Humane Society property.

 

I also hereby give the Nebraska Humane Society authority to seek emergency medical treatment for said child. I further attest that I know of no medical or other condition that would prevent said child from participation in activities at the Nebraska Humane Society.

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