Critter Camp Registration 2015

Critter Camp Registration
Camp Information
Your Information
During the week-long camp, attendees learn about cats,
dogs, wild animals and exotic animals. Older children
interested in veterinary medicine are allowed to watch
a spay or neuter surgery done in the shelter's very own
veterinary clinic.
Child’s Name: __________________________________
Cost is $150 for one child per session. If a family is
registering more than one child, the cost is $125 per
child. That includes a t-shirt and snacks at the shelter.
Campers will need to bring their own lunches. Please
make checks payable to Cheyenne Animal Shelter
Foundation.
Daytime Phone: _________________________________
2015 Critter Camp dates and ages:
(All classes are for students that have completed
kindergarten through 5th grade)
Email Address:
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June 15—June 19
July 6—July 10
July 27—July 31
August 10—August 14
Age (during week of camp)
Parent’s Name: _________________________________
Billing Address: ________________________________
______________________________________________
Please rank the desired week to attend:
First Choice: __________ Second Choice: ____________
Please list any medical or special needs, allergies or
limitations:
______________________________________________
Emergency Contact/Relationship:
Phone #1: _____________________________________
Phone #2: _____________________________________
T-Shirt Size: (Please Circle One)
Youth Small (6-8)
Adult Small
Youth Medium (10-12)
Adult Medium
Youth Large (14-16)
Credit Card:
VISA
Mastercard
Discover
Card #: ________________________________________
Potential scholarship opportunities.
Legal Information
I, ________________________________, do recognize that
in conjunction with my child, ________________________’s
Critter Camp attendance at the Cheyenne Animal Shelter
(CAS), my child will be in contact with and may be allowed
to hold and pet animals. I understand there is a chance that
my child may contract a disease or illness in handling the
animals. I also understand that there is a chance than my child
may sustain a scratch or bite while handling animals.
I understand that the above is illustrative of the types of risks
involved in participating with the Cheyenne Animal Shelter’s
Critter Camp, but is not a complete list of possible risks.
By signing my name below, I do hereby absolutely and
unconditionally release and discharge the Cheyenne Animal
Shelter, including its employees, successors, assigns,
directors, officers, and agents, from and against any and all
claims, obligations and liabilities, of every nature and kind
whatsoever, relating to or arising out of my child’s
participation with the Cheyenne Animal Shelter’s Critter
Camp.
In case of injury to my child, I request the Cheyenne Animal
Shelter to contact me. If the Cheyenne Animal Shelter is
unable to reach me or the emergency contact, I authorize the
Cheyenne Animal Shelter to make whatever arrangements
deemed necessary.
I certify that I am the above child’s legal parent or legal
guardian: YES
NO
I authorize the Cheyenne Animal Shelter to use my child’s
name, photograph, and video image for public relations both
in their newsletter and on the website
www.cheyenneanimalshelter.org: YES NO
(For children completed grades 4-5) If my child is interested
in participating, I authorize my child to watch a spay or
neuter in the Cheyenne Animal Shelter’s Veterinary Clinic.
YES NO
Expiration Date: ________________________________
Parent/Guardian’s Signature:
Authorized Signature: ____________________________
_________________________________________________