APRIL VACATION CAMP REGISTRATION FORM MONDAY-FRIDAY ・ APRIL 20-24, 2015 ・ 9AM – 4PM For students ages 7-10, daily workshops focus on animal care & handling and animal welfare-related issues. Students have the opportunity to interact with a variety of pets, play games, and make crafts. Snacks are provided, but bring a lunch. The cost is $125. For more information contact [email protected] or 985-3244 x 109. Child’s Name: DOB: (must be at least 7 years old) Street Address: City/State/Zip Code: Parent/Guardian: Email: Best phone number(s) for us to reach you: Name and Phone of Health Care Provider: Does Child have ANY Known Allergies? If Yes, to what? (Unfortunately Children with Cat/Dog or Peanut Allergies Cannot be Accommodated): Special Needs or Medications? Please List or Attach a Note: Thank you for enrolling your child in this Animal Welfare Society Humane Education program. In accordance with section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990, the Animal Welfare Society (AWS) invites you to identify any physical or mental disability or behavior that would preclude your child from fully participating in the program. We are committed to complying with the requirements of the Acts set forth above. In this regard, AWS, to extent required by law, will provide reasonable accommodations to participants who require them in order to participate in the program. Individuals with disabilities are not required to self-identify at any time. However, AWS is only required to provide reasonable accommodations for known disabilities. If your child needs a reasonable accommodation(s) in order to participate in our program, you must include that information with registration. AWS will make every effort to provide reasonable accommodation should your child have special needs. As we are not in a position to provide one on one attention, your child must fully participate in all activities. For the safety of and fairness to the group, if your child is unable to or refuses to participate, you will be called and asked to pick him/her up. I agree to assume all responsibility for any and all risk, damage or injury that may occur to my child/ward as a participant in The Animal Welfare Society’s April Vacation Camp. In consideration of my child/ward being accepted as a participant, I hereby for myself, my heirs, minor child or ward, and executers and administrators of all the foregoing, release and discharge The Animal Welfare Society, the volunteers, and all persons associated herewith from all claims and damages resulting from or arising out of, or incident to my child/ward’s participation in the program. I agree to permit the free use of my child/ward’s name and picture in any broadcast, telecast or other account of the event. After care is not available so please be sure to pick your child up promptly at the end of each day. Signature of Parent/Guardian: Printed Name: Date: Please include payment of $125.00 with this registration and mail to the address listed above. ATTENTION: MEGAN CROSS, OUR HUMANE EDUCATOR WILL CONTACT YOU IN A TIMELY MANNER TO CONFIRM REGISTRATION.