Parent/Guardian Phone Number
Please enter a valid phone number.
Is there anything we should know about this student? For example, allergies.
What kind of programs are you interested in?
By signing you agree that you are the responsible party, and have legal authority to sign for the student listed above.
Youth Media Release: By signing below, you grant permission to Misty Eyes Animal Center to use photographs and/or video of the student above taken during their time as a volunteer in publications, news releases, online, and in other communications related to the mission of Misty Eyes Animal Center.
I recognize that in handling animals and performing other volunteer tasks there exists a risk of injury including physical harm caused by the animals. On behalf of myself, my heirs, person representatives, and executors, I hereby release, discharge, indemnify and hold harmless this organization, its agents, servants, and employees from any and all claims, causes of action, or demands, or any nature or cause, including costs and attorney’s fees incurred by this organization in connection with the same, based on damages or injuries which may be incurred or sustained by the student listed above in any way connected with my services for this organization, including but not limited to animal bites, accidents, or injuries.
Should be Empty: