Prince Albert Junior Historical Society
Membership Application Form 2024/2025
Participant #1 Name
*
First Name
Last Name
Participant's Birthdate
*
-
Month
-
Day
Year
Date
Participant #2 Name
First Name
Last Name
Participant's Birthdate
-
Month
-
Day
Year
Date
Address
Street Address
Street Address Line 2
City
State
Postal Code
Parent/Guardian
*
First Name
Last Name
Home/Cell Number
Please enter a valid phone number.
Home/Cell Number
Please enter a valid phone number.
Parent/Guardian Email
*
example@example.com
Emergency Contacts / Pick Up Contacts
Name
Relationship to Child
Phone Number
Name
Relationship to Child
Phone Number
Name
Relationship to Child
Phone Number
Does your child have any allergies, dietary restrictions, existing illnesses or any medical conditions?
*
Which group will your child/children attend?
Jr. Historical Society Saturday Group - 3rd Saturday of the month
Jr. Historical Society Homeschool Group - 3rd Wednesday of the month
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Liability Release and Parental Consent Form
In consideration of the acceptance of my application for the Prince Albert Historical Society summer program, I hereby waive, release, and discharge any and all claims for damages for personal injury, property damages or which may hereafter occur to my child as a result of their participation in said summer program. This release is intended to discharge in advance the Prince Albert Historical Society, its officials, officers, employees, volunteers, and agents from liability, even though that liability may arise out of perceived negligence on the part of persons mentioned above. It is understood that some recreational activities involve an element of risk or danger of accidents, and knowing those risks, I hereby assume those risks. It is further understood and agreed that this waiver, release, and assumption of risk is to be binding on my heirs and assignees.
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Photo Release Form
I hereby authorize the Prince Albert Historical Society to publish the photographs or videos taken of me and/or the minor children listed below, for use on the Prince Albert Historical Society website and/or Prince Albert Historical Society social media and for display in the museum facility. I release the Prince Albert Historical Society and the summer program from any expectation of confidentiality for the minor children and myself and attest that I am the parent or legal guardian of the child or children listed below and that I have the authority to authorize the Prince Albert Historical Society and the summer program to use their photographs. I acknowledge that since participation in publications and websites produced by the Prince Albert Historical Society or the summer program is voluntary, neither the minor children nor I will receive financial compensation. I further agree that participation in any publication and website produced by the Prince Albert Historical Society or the summer program confers no rights of ownership whatsoever. I release, the Prince Albert Historical Society, its officials, agents, volunteers, contractors and its employees from liability for any claims by me or any third party in connection with my participation or the participation of the minor child or children listed below.
*
I have read and understood the Photo Release Form, and accept the terms.
I decline to have my child’s photo taken and/or used.
Photos may be taken, but please do not show their face.
*
I understand that payment of the $20 annual membership fee per child is required at time of application
I will pay by etransfer to finance@historypa.com
I will pay in person at the museum.
I will call (306)764-2992 and pay with my credit card.
I wish to receive PAHS information regarding meetings or events, etc. by email. I may unsubscribe at any time by notifying the Society
Yes
No
Parent/Guardian Name
*
First Name
Last Name
Date
*
-
Month
-
Day
Year
Date
Questions?
Please call Jeri at (306) 764-2992
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