Registration Form

Registration: Camp Pawprint-Summer Break (06-12-2017 - 08-25-2017 )

NOTE: Dane County Humane Society utilizes peanut butter for animal enrichment throughout the shelter, and therefore is unable to provide a peanut-free facility. We are unable to make accommodations for children with severe peanut allergies.

USER INFORMATION
First Name:
Last Name:
Camper Information - One child only! If registering multiple children, please register each one separately. Please wait 10 minutes between registrations so our system can reset. Thank You!
Camper First Name:
Camper Last Name:
Gender:
Male  Female  
Birthday (mm/dd/yyyy):
Medical or behavioral conditions we should be aware of:
HUMANE HELPERS:
June 12-16 (full!)
July 10-14 (full!)
July 31-August 4 (full!)
August 21-25 (full!)
CREATURE CAREERS:
June 19-23 (full!)
July 17-21
August 7-11 (full!)
GO WILD!:
June 26-30
July 24-28 (full!)
August 14-18 (full!)
Aftercare is available from 3-5pm. Aftercare Fee $65 X (# of weeks):
Please include full contact information for the primary guardian of your camper in the first set of fields and emergency contact in the second set of fields.
Guardian First Name:
Guardian Last Name:
Address:
City:
State:
ZIP:
Contact Email:
Phone:
Emergency Contact First Name:
Emergency Contact Last Name:
What is the emergency contact's relationship to the camper (ie. . father, mother, grandparent):
Email:
Phone:
The undersigned parent or guardian of the above named child (“Minor”) hereby consents to the Minor participating in Camp Pawprint of Dane County Humane Society, Madison, Wisconsin (the “Society”) and all of its activities and programs. The undersigned, for herself or himself and on behalf of said Minor, does hereby and unconditionally release, indemnify, hold harmless and forever discharge the Society, its employees, successors, assigns, and agents and each of them, from and against any and all claims, demands, obligations and liabilities of every nature and kind whatsoever, including, without limitation, negligence, occurring during, directly or indirectly resulting from or arising out of the Minor’s participation in such Camp Pawprint. As to matters covered hereby, the CONSENT AND RELEASE shall extinguish all claims, demands, and rights which the undersigned or the Minor (and/or each of their heirs, successors, and assigns) has or may have against the parties released hereby, or any of them, for any injuries, costs or damages to the Minor occurring during, directly or indirectly resulting from or arising out of the Minor’s participation in such Camp Pawprint whether such injuries, costs or damages are known or unknown, foreseen or unforeseen, ascertainable or unascertainable. The undersigned also agrees that Dane County Humane Society may photograph the Minor’s participation in Camp Pawprint and hereby releases any such photographs to Dane County Humane Society for its use in programs, publications and purpose.
Signed:
Yes
Name:
Date:
How did you hear about this event?: