Winter Camp

Winter Camp

Humane Society of West Michigan offers a fun and exciting experience at our Winter camp! Winter camp is a great place for your child to learn, grow, and make new friends! December 22nd, 23rd, 26th, 29th, 30th, and January 2nd. Register for a day or for all the days!!!
Child's Name:*

First NameLast Name
Child's Age:*
Child's Date of Birth:*
YesNo
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number:*
Email:*
example@example.com
Emergency Contact (if you are not available):*

First NameLast Name
Relationship:*
Emergency Contact Phone Number:*
Please enter a valid phone number.
Name(s) of those authorized to sign OUT a camper:*
Medical Considerations (allergies, physical, or behavior limitations, etc.):*

Parent/Guardian Name(s):*

First NameLast Name
Camp Date Selection

Payment

Monday, December 22

$60.00

Tuesday, December 23

$60.00

Week One

December 22, 23, and 26 Save $30 by registering for the three-day week!

$150.00

Monday, December 29

$60.00

Tuesday, December 30

$60.00

Friday, January 2

$60.00

Week Two

December 29, 30, January 2 Save $30 by registering for the three day week!

$150.00

Enter coupon

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Release, Waiver of Liability and Indemnification Agreement.

Please sign the below to accept our terms & conditions.
In consideration for my (our) child above being permitted to participate in Humane Education Camp activities provided by Humane Society of West Michigan, its employees, agents, volunteers, and/or affiliates (collectively referred to as “HSWM”), I (we), agree to the following: I understand that my child will be interacting with unfamiliar animals throughout the term of the camp. I certify that there are no physical, emotional, or mental problems or limitations associated with my child’s participation in these or any other camp activities. While the Camp animals have been temperament tested by HSWM and HSWM in good faith believes the animals will be safe for interaction with the public, animals by their nature are unpredictable and there are many factors that can affect their behavior. HSWM will have complete discretion in determining how to react in all circumstances including unpredictable animal behavior. I understand that there are unpredictable risks and dangers inherent to interacting with any animal. For myself and my child, I acknowledge and assume the risks involved in these inherently dangerous activities, and for any damage; illness; injury; including, without limitation, animal bites, lacerations, or scratches; or death resulting from such activities. I certify that I have the authority to enter into this agreement on behalf of my child and release and waive any claims that I or my child may have against HSWM with respect to any loss; injury, including, without limitation, animal bites, lacerations, or scratches; illness; damage; or death occurring to my child while he/she is in the custody and care of HSWM as well as any related claims that I may have. I agree to indemnify and hold harmless HSWM from and against any and all liability and costs (including attorney fees) related to any such claim asserted against HSWM by or on behalf of my child or me. I agree that this release, waiver of liability and indemnification agreement is intended to be as broad and inclusive as permitted by the laws of the of Michigan, and that if any portion there of is held invalid, it is agreed that the balance shall not with standing continue in full legal force and effect. In the event of an accident or injury to my child, I authorize HSWM to make whatever transportation, diagnosis, and/or treatment arrangements as they, in their sole discretion, deem to be appropriate in the circumstances. I agree that my insurance or I personally will be liable for any costs incurred for the transportation, diagnosis, and/or treatment of my child. Transportation, diagnosis, and/or treatment of my child should proceed whether or not I can be contacted. Below I am providing my contact phone number(s) and HSWM is not responsible to identify any other means to contact me if that is unsuccessful. I grant HSWM the right to use my name, portrait, photograph, video segment, likeness, or other image, and those of any minor named below, on whose behalf I am signing, for marketing, public relations, and/or educational purposes. I grant HSWM the right to use the name or image described above in print, video and/or electronic media. I understand that HSWM retains all rights to use, publish or distribute the portraits, photographs, video segments, likenesses, or other images and has the right to do so without seeking any further permission from me or providing me any royalty. I understand that notification is not a condition to HSWM’s use or publication of my name or image for marketing, public relations and/or educational purposes. I understand that no refunds will be issued for this camp. Please Note: Animal time during camp may be limited or varied depending on the day, the camp, and what animals we have at the time. Shelter animals are in an extremely stressful environment, and our goal is to provide the campers and animals with a safe and enriching experience. We appreciate your patience and understanding as we all strive to provide shelter animals and campers a safe environment. I HAVE READ AND UNDERSTAND THE ABOVE AND AGREE TO BE BOUND BY THE TERMS OF THIS DOCUMENT.*
Insurance Provider:*
Policy #:*
Child's Physician: *

Please verify that you are human*
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Winter Camp

Camp Date Selection

Release, Waiver of Liability and Indemnification Agreement.