Support NHS

1.

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

*

Name:

First Required	Last Required

*

Email: Required

Street 1:

Street 2:

City/State/ZIP:

City	State	ZIP

*

Phone Number: Required

Yes, I would like to receive e-mail from Nebraska Humane Society

Keep me logged in. What's this?

*2.

Question - Required - Please provide an emergency contact number:

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

*3.

Question - Required - Child's First Name

*4.

Question - Required - Child's Last Name:

*5.

Question - Required - Child's Age:

*6.

Question - Required - Child's Date of Birth:

Month

Day

Year

*7.

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

Small

Medium

Large

XL

XXL

8.

Question - Not Required - If someone other than you will be picking up your child, please list their name and phone number below.

*9.

Question - Required - Has your child ever attended Humane Hands?

*10.

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

	attended before
	friend/family
	NHS emloyee
	attended camp kindness
	NHS website
	NHS event
	social media
	other

11.

Question - Not Required - If your child has any allergies (including animals) please list them here:

12.

Question - Not Required - If your child will need any medication during Humane Hands, including an inhaler or epipen, please list them here. *NHS staff may call you to clarify these medications:

13.

Question - Not Required - If you child has any special needs (medical, behavioral, physical restrictions, etc.) please list them here:

*14.

Question - Required - From time to time the Nebraska Humane Society uses slides, or photographs of various educational activities. If you would be willing to allow us to use pictures of your child taken during Humane Hands as part of our public service or educational materials, please indicate by answering yes to opt in or no to opt out below.

Humane Hands Wavier & Release of Liability

*15.

Question - Required - As parent/legal guardian of: (Insert child's last name/ first name and age)

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.

*16.

Question - Required - I have read, fully understand, and voluntary sign this Parent/Guardian Waiver and Release of Liability Form. Please Enter Parent/Guardian Name

*17.

Question - Required - Relationship to minor

2021 Humane Hands registration form

Humane Hands Wavier & Release of Liability

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