Kids for Canines Registration Form
Participant First Name and Last Name
First Name
Last Name
Participant Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Participant Email Address
example@example.com
Parent/Guardian Name
First Name
Last Name
Parent/Guardian Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian Email Address
example@example.com
Participant Age
Participant Tshirt Size?
Participant school?
Is the Participant part of a club/society that requires volunteer service hours? If yes, please list the club and school
Parent/Guardian Permission & Releases
I give permission for my child to participate in Kids for Canines activities, including hands‑on learning, demonstrations, and supervised interactions with dogs.
Yes
No
Photo/Media Release
Kids for Canines may take photos/videos during activities for educational and promotional use.
Yes, my child may appear in photos/videos
No, my child may NOT appear in photos/videos
Dog Interaction Permission
I give permission for my child to interact with fully vaccinated, behavior screened dogs under supervision
Yes
No
Health and Safety Information
Does your child have any allergies?
No
Yes
If you answered yes in the above question, please list the allergies:
Does your child have any medical, behavioral, or learning needs we should be aware of to keep them safe and comfortable?
Is your child afraid of dogs or has had a negative dog experience, if so, please explain:
We will communicate exclusively via email about anything K4C related, please make sure to check your email for monthly club meetings.
I understand
How did you hear about Kids for Canines?
School
Social Media
Friend
Event
Flyer
Other
Volunteering/Parent Engagement - Would you like to volunteer for events or projects?
Yes
No
Maybe later
Does your child need any accommodations? If yes please explain:
Liability Waiver:
I understand Kids for Canines takes safety seriously and all activities are supervised. I release Kids for Canines and its volunteers from liability for minor accidental injuries that may occur during normal program activities.
I understand and agree
Parent/Guardian Agreement
I confirm all information is accurate, and I agree to follow the Kids for Canines rules and safety guidelines.
Signature
Continue
Continue
Should be Empty: