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2021 Humane Education Camp Registration
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First Name
Last Name
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Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country
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First Name
Last Name

Please note, this camp is only available to children ages 8 to 12.
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(mm/dd/yyyy)

First Name
Last Name

Please note, this camp is only available to children ages 8 to 12.

(mm/dd/yyyy)
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Please note:

SICSA is not able to administer medications during camp. If a child has medication they must take during camp hours, they will need to administer the medication themselves, or have a parent, legal guardian, or designated medical professional come to the facility at the appropriate time to do so. If you have any questions regarding your child's specific needs, please contact Kaitlin Becraft at kbecraft@sicsa.org for further infromation.

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First Name
Last Name
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First Name
Last Name
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Informed Consent, Acknowledgement, and Release
  1. I, the undersigned, am the parent and/or legal guardian of the above-named child/children. By signing below, I hereby agree to, acknowledge and give my consent without reservation to the following on my own behalf and on behalf of my child, as of the date chosen above.
  2. I have voluntarily enrolled my child in, and my child has voluntarily agreed to participate in, certain activities occurring at SICSA Pet Adoption and Wellness Center (“SICSA”) for multiple days or specific event (the “Humane Education Summer Camp”). I understand and agree that my acceptance of the terms and conditions of this Agreement, and my child’s strict adherence to the established rules, guidelines and protocols of SICSA, are conditions of my child’s participation in the Event.
  3. I understand that my child’s privileges may be revoked or suspended at any time for non-compliance or safety issues, or for my breach of this Agreement in any way, as may be determined by SICSA in its sole discretion.
  4. I understand that my child may be interacting with animals belonging to SICSA. I understand that animals, even under the best of circumstances, may be unpredictable, may bite or scratch and may transmit zoonotic diseases.  I understand that SICSA specially recommends that visitors to SICSA’s premises maintain current tetanus vaccinations and that I am encouraged to consult with a medical professional to decide whether or not my child should be vaccinated against tetanus and to properly address any medical questions or concerns prior to my child’s participation in the Event.  
  5. I understand that my child’s attendance is purely voluntary and not without risk of injury, including but not limited to, serious physical harm to my child. I recognize and agree that SICSA, together with its officers, directors, instructors, agents, volunteers, employees, predecessors, successors, affiliates and representatives (collectively, the “Released Parties”), assumes no responsibility for any liability, damage, expense (including medical care), cost, fee (including attorneys’ fees), claim, demand, loss, obligation, settlement agreement, injury or illness, suit at law or in equity, whether in whole or in part, foreseeable or unforeseeable, known or unknown, fixed or contingent, suspected or claimed, that I or my child may have ever had or now have against the Released Parties arising from or otherwise relating to my child’s participation in the Event or my decision to permit my child to participate in the Event (collectively, the “Claims”), including but not limited to, any Claims caused directly or indirectly by any negligence (active or passive) attributable to the Released Parties or my decision to not vaccinate my child against tetanus or any third-party Claims brought by my guest(s), if any. For the avoidance of doubt, I agree that if my child is injured on SICSA’s premises in any capacity whatsoever, I am aware that my own health insurance coverage will provide for any necessary medical treatment or care for my child. In consideration of, and as an inducement to, the acceptance of my child’s participation in the Event, and for other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, I (together with my spouse, heirs, successors, executors, administrators, agents, personal and legal representatives and assigns) agree to forever release, discharge, indemnify, and hold harmless the Released Parties for any and all Claims.
  6. I understand that my child is expected to treat all property located at SICSA’s facilities with respect. I recognize that I am solely responsible, financially and otherwise, for the actions or inactions of my child (and me) while participating in the Event, and I agree to assume full financial responsibility for any and all damages to, or losses of, the real or personal property of SICSA or any third party caused directly or indirectly, in whole or in part, whether or not foreseeable, by my child (and me), as determined by SICSA in its sole and absolute discretion, and I further agree to indemnify and hold harmless the Released Parties from any third-party claims related thereto. 
  7. I understand that public relations are an important part of the activities conducted at SICSA. Thus, SICSA has permission to use without notice or compensation my or my child’s likeness in any and all photographs, video and images, and to further include his/her name in any materials that promote the SICSA’s services and programs, or to publicize any event, or for any other lawful purpose (including but not limited to, the right to edit, alter, copy, publish or distribute). I understand and agree that all film, prints and negatives become the sole property of SICSA and may be used by SICSA without payment or royalties or any other consideration or prior notification.

This Agreement supersedes all prior discussions, representations, warranties and agreement, and expresses the entire agreement between SICSA and me regarding the subject matter herein. This Agreement may be amended only by a written instrument signed by both parties. This Agreement shall be interpreted in accordance with the laws of the State of Ohio. All claims, disputes and lawsuits arising out of or in connection with this Agreement shall be resolved or adjudicated in Montgomery County. If any provision of this Agreement is deemed invalid, void or unenforceable, such provision shall be considered severed from the Agreement and the remaining provisions shall be given full force and effect.

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By typing your legal name in the provided box, you acknowledge and agree to all terms provided above.