PLEASE CAREFULLY READ THIS ENTIRE WAIVER & RELEASE FORM
This form has been written to provide you with the needed information about the guidelines, activities, and insurance coverage that will apply while your child attends Northshore Humane Society’s Summer Camp.
GENERAL RELEASE AND CONSENT
In consideration of the privilege of participating at the Northshore Humane Society’s Summer Camp, I/we the parent(s)/guardian(s) hereby voluntarily release and discharge the Northshore Humane Society, its officers, management, volunteers, and employees from any and all claims for injury, illness, death, loss or damage, which my child may suffer as a result of his /her participation in these activities of Northshore Humane Society. I/we understand that the Northshore Humane Society assumes no responsibility for injuries and illnesses which my child may sustain as a result of his/her physical condition and or resulting from his/her participation in any athletic, arts & crafts, dog/cat activities, the use of any equipment, exercise, or any/all other activities.
PERSONAL PROPERTY AGREEMENT
I understand that the Northshore Humane Society is not responsible for personal property, whether it be damaged, lost or stolen while members and/or program participants are using the Northshore Humane Society facilities or on the Northshore Humane Society premises.
MEDICAL CONSENT
In the event of an emergency and I the parent/guardian nor the emergency contact person cannot be reached, I hereby give permission to Northshore Humane Society to contact the physician I specified on my child’s NHS Summer Camp Registration, to hospitalize, secure proper treatment for, and to order injections, anesthesia or surgery, or to call for an ambulance [in case of immediate emergency] for the individual named on this agreement. Northshore Humane Society shall not be liable for any resulting medical treatment or medical bills for any provided services. I understand that all medical bills are my responsibility. I understand that no accident or medical insurance is provided at Northshore Humane Society with this activity. I understand that in the event my child needs any medical care, all medical costs [doctors, hospital, long term treatment, etc.] are at my expense.
I understand that temporary emergency measures may be necessary to safeguard my child’s health, and do hereby authorize and request the Northshore Humane Society personnel to administer or supervise such treatment and to do any procedure that they deem necessary until such time as my child can be safely transported to a doctor or hospital and I authorize reasonable medical care for my child if necessary.
PHOTOGRAPHY/AUDIO/VIDEO STATEMENT
I give my permission to the Northshore Humane Society to use, without limitation or obligation, photographs, film footage, audio recordings, or tape footage which may include my child’s image or voice for purposes of promoting or interpreting to the Northshore Humane Society programs on, but not limited to social media, informational videos, grant applications, etc.
CAMP AGREEMENT
I understand and have explained to my child that his/her attendance at this camp is a privilege, not a right, and is conditioned on his/her acceptable behavior. I realize that camp is something that will substantially benefit my child, and behavior that contravenes the following guidelines may result in his/her dismissal from camp in the Northshore Humane Society Camps sole discretion. In consideration of the benefits of this camp to my child and other good and valuable consideration, receipt of which is hereby acknowledged, I agree to the following: [camper and parent/guardian must initial next to each statement]
