Registration Form for Animal Ambassador Club

I, the undersigned parent/guardian, understand that the participation of my child designated below (the “Student”) in an RISPCA Educational Program, may involve activities with a certain degree of risk and which may be physically, mentally, and emotionally demanding. I also understand that participation in these activities is entirely voluntary and requires the Student to abide by applicable rules and standards of conduct. I acknowledge that failure to comply with the program rules potentially jeopardizes the safety of the Student and other participants and may result in the Student’s dismissal. Prior to the start of the program, I will engage in a discussion with the Student and will instruct and encourage the Student, to the best of their ability, to follow all instructions given by staff and to ask for assistance if necessary. I will also inform the Student that, while they are encouraged to engage in all activities offered, they are not required to engage in any activity if they are uncomfortable doing so and that they will not be criticized or penalized if they elect not to participate in any activity offered. I am aware that my Student will be introduced to and will have supervised contact with a number of domestic animals and will also be engaging with other children of similar age and that unanticipated behaviors may be encountered. I have considered these risks and accept them on behalf of myself and Student. In case of an emergency involving Student, I understand that the Rhode Island SPCA will attempt to contact me by telephone and I agree to provide a contact telephone number or numbers for that purpose and to inform the Rhode Island SPCA of any change in my contact information. If I cannot be reached, I authorize the Rhode Island SPCA to contact another a parent/guardian (if applicable) or any designated emergency contact. In the event such persons cannot be reached, I grant permission for the Rhode Island SPCA to authorize and secure emergency medical treatment for the Student, which may include hospitalization, anesthesia, surgery, or injections of medication, as necessary. In such an event, I authorize the Rhode Island SPCA to share with health care providers and other necessary individuals to facilitate Student’s medical treatment any health care information concerning Student which may be relevant to the Student’s emergency treatment. I agree to provide the Rhode Island SPCA with information concerning any allergies the Student may be known to have and to provide the name of the Student’s physician and information about any applicable health insurance coverage. I authorize the RISPCA to contact the Student’s physician in the event of any emergency and to share any information concerning any medical emergency with the Student’s physician, the Student’s other parent/guardian (if applicable), and with any person designated as an emergency contact for the Student. I, on behalf of myself and Student, and on behalf of our heirs, agents, representatives, executors and administrators, hereby release, indemnify, quit, hold harmless and forever discharge the Rhode Island SPCA and its directors, officers, employees, agents and volunteers and its and their respective successors and assigns from and against any and all liabilities, obligations, damages, penalties, claims, actions, causes of action, demands, judgments, executions, costs (including reasonable attorneys’ fees), charges, loss of services, expenses, compensation, and any and all other claims whatsoever, both at law and in equity, which I, Student, or any third party might incur or might assert in connection with the operation of the RISPCA Program and/or the Student’s participation in the program.