Parent/Legal Guardian Name
*
First Name
Last Name
Email
*
Childs Name
*
First Name
Last Name
Birthdate
*
MM
DD
YYYY
Phone Number of Parent/Guardian
*
Address
*
Please include, street, city & zip
Alternate Emergency Contact
*
Other than Parent/Guardian
First Name
Last Name
Emergency Contact Phone #
*
Emergency Contact's Relationship to Child
*
Social Media Consent
*
Please check all that apply
Parental Waiver
*
I, the undersigned, as the parent or legal guardian of the child/children named below, do hereby give my full consent and approval for my child/children to participate in Friends of Michigan Animals Rescue (FMAR) Kids Club (referred to in this form as “Activity”) which will be held at FMAR located at 51299 Arkona Rd. Belleville, MI 48108
I understand that the very nature of the Activity is hazardous and risky. I understand that there are certain risks of bodily injury, death or property damage that may occur during or as a result of participation in the Activity. I agree to assume all of these risks on behalf of my child/children. These risks include, but are not limited to, those hazards associated with other participants, volunteers, instructors, equipment, animals, my child’s/children’s health condition(s), and others not known to me.
Further, I agree that in consideration for the right to allow my child/children to participate in the Activity:
On behalf of my child/children and myself, I do voluntarily elect to accept and solely assume all risks of damage, theft and/or injury incurred or suffered by my child/children: (a) while participating in the Activity; (b) while observing others participate in the Activity; and (c) while on or upon the premises of any and all of the locations arranged for performance of the Activity.
In addition to giving my full consent for my child’s/children’s participation, I do hereby waive, release, discharge and agree not to sue FMAR, its affiliates, directors, officers, employees, volunteers, agents, and contractors (“Releases) for any claim, damages, costs including attorney fees, or cause of action which I or my child/children have or may have in the future as a result of damages, injuries, including death, sustained or incurred by my child/children from whatever cause including, but not limited to, my child’s/children’s conduct and/or the negligence or wrongful conduct of the parties of the Releases.
I agree on behalf of myself and my child, that I shall hold harmless and fully indemnify the Releases from any and all claims, damages, costs including attorney fees, and causes of action which may arise from any cause of action made by me or by, through or on behalf of my child, even if the damages, injuries or death are caused in whole or in part by any of the Releases.
I agree that if any portion of this Form is determined by a court of law to be invalid, that the remainder will continue in full force and effect. I further agree that the contents of this Form shall be construed to provide the broadest waiver, release, indemnification, and consent possible.
