PAWSitive Reading Sign-Up Humane Society of Valdosta/Lowndes County
If you have any questions about this form, please contact us at (229) 247-3266.
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Parent/Guardian First & Last Name
Child's First Name
Are you registering any more children?
If you answered yes, please enter their names below:
Phone Number (ex: 229-555-1234)
As legal parent or guardian, I give permission for my child/children to attend Pawsitive Reading. IN CONSIDERATION of participation with cats and dogs, the undersigned, on behalf of the Child, himself/herself, his/her successors and assignees, hereby releases, agrees to hold harmless and forever waives and discharges the Humane Society of Valdosta/Lowndes County, Lowndes County, and host site, its agents, employees, directors, and all liability insurance carriers from all action, damages, or judgments which may occur now or in the future, for all injuries arising out of the activities while attending Pawsitive Reading. I acknowledge and am aware that this program involves certain inherent risks. These risks may include, but are not limited to, walking on uneven ground, weather, and other people’s actions. While the Humane Society of Valdosta/Lowndes County will make every attempt to provide reasonable accommodations for mentally and physically challenged children, the Humane Society will not accept children who are (1) a danger to themselves, (2) a danger to others, (3) a danger to the animals, or (4) a disruption to normal program activities making it unreasonably difficult for other children to enjoy Pawsitive Reading. Any of the above reasons will be grounds for dismissal. Please discuss with staff any special conditions or circumstances involving your child. We request that you do this PRIOR to the first reading session so that we can advise you as to whether we can make a reasonable accommodation for your child. I give my permission to the Humane Society of Valdosta/Lowndes County and host site to use, without limitation or obligation, photographs, or video that include my child’s image or voice for the purpose of promoting programs.
I agree to the above terms
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