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Friday, 04 April 2014 03:18

2017 Critter Kiddz Camp!

Kiddz Camp Revised

 

NOTICE: Registration is fully booked for ages 9 through 13; registration remains open for ages 6 to 8.


Critter Kiddz Camp Registration / Waiver and Release of Liability Form

  1. PART 1: WAIVER AND RELEASE OF LIABILITY

  2. (Please fill out a separate form for each child)

    I understand the nature of the activities that my child will be participating in during the week/s of July 17th or July 24th, 2017, at the Riverside County, Western Riverside Animal Shelter during Critter Kiddz Camp. I also understand the nature of domestic animals and that their behavior is sometimes unpredictable which can give rise to risks such as personal injury. Knowing this, I, and anyone who might claim on my behalf, release the Department of Animals Services, the ASK Foundation, the County of Riverside, its Agencies, Districts, Special Districts, and Departments, their respective directors, officers, Board of Supervisors, employees, elected or appointed officials, agents or representatives from any and all claims and liability of any kind arising out of personal injury and property damage resulting from my child’s participation in activities during Critter Kiddz Camp.

    In the event that my child requires medical attention, I authorize Riverside County Department of Animal Services to seek proper medical help at my cost.

    I have listed below all of my child’s known allergies, all of my child’s physical limitations and any special needs that my child might have. In addition, I have no knowledge of any medical condition that would prevent my child from participating in the activities at Critter Kiddz Camp.

    Photo Release:

    By signing this form, I grant the right to photograph, reproduce, and use said child’s artwork, written work, picture, silhouette, and other reproductions of physical likeness in connection with Riverside County Department of Animal Services’ and the ASK Foundation’s promotions.

    By filling out this form and entering my name below, I have read, understand and agree with the statements above.

  3. Name (electronic signature):*
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  4. For (Child’s name):*
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  5. Emergency Medical Information:
  6. Any known allergies:
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  7. Any physical limitations or other needs:
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  8. Health care provider’s name, phone number and address:*
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  9. Insurance carrier and policy number:*
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  10. Emergency contact name and phone number if parents cannot be reached: (please list two)*
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  11. Parent/legal guardian information:
  12. Address:*
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  13. Home Phone:*
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  14. Work Phone:
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  15. Mobile Phone:
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  16. Other individuals authorized to pick up my child:
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  17. PART 2: REGISTRATION

  18. I am interested in signing my child up for the week of:*

    Please select a week.
  19. Name of Participant:*
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  20. Age:*
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  21. Sex:*

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  22. Parent or Legal Guardians Name:*
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  23. Phone (example: 123-456-7890):*
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  24. Email:*
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  25. Address:*
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  26. City:*
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  27. State:*
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  28. Zip:*
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  29. How did you hear about Critter Kiddz Camp?*
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  30. HOW TO PAY:

    The cost of Critter Kiddz Camp is $100 per week. ($25 discount for a second child, or signing up for both weeks)

    You must register and pay for each child separately.

    Once registration is complete, you will be redirected to Paypal through the ASK Foundation for payment.

    PAY BY CHECK

    Payments by check (made out to the ASK Foundation) or cash can be brought into the shelter to Laurie Dozier at:

    Attn: The ASK Foundation
    Riverside County Department of Animal Services
    6851 Van Buren Blvd.
    Jurupa Valley, CA 92509

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For your convenience, we accept payment by Visa and Master Card.  We do not accept American Express or Discover credit cards.  We do not accept credit card numbers over the phone or through the mail.

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