Youth Program Registration and Payment

Application

Adult's Name*

First Last

Child's Name*

List all children you are enrolling in the Youth Program

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Email*

Child's Birthday*

Mom's Cell Phone

Dad's Cell Phone

Guardian's Cell (if applicable)

Briefly, please describe why your child is interested in volunteering for a group dedicated to rescuing pets*

Does your child have any food allergies that we need to be aware of?*

Yes
No

If Yes, please explain*

Does your child have a medical condition?*

Yes
No

If yes, please describe. If necessary provide your doctor's name and phone number*

Does your child have any behavioral issues we need to be aware of?*

Please keep in mind that if we don't know about something we can't help either.

Yes
No

If Yes, please explain*

Has your child ever been bitten/attacked by a dog?*

Yes
No

If Yes, please explain

Is your child comfortable approaching dogs that they do not know?*

Yes
No

Do you understand that dogs may be unpredictable and that AEAR cannot guarantee that a dog we are attempting to rescue may become aggressive?*

Yes
No

Are you willing to assume the risks involved with your child working with animals who are sometimes frightened and who are in unfamiliar surroundings and the possibility that the dog may become aggressive and/or bite your child?*

Yes
No

Do you give permission for your child to be photographed and for those photos to be added to the website and or written literature?*

Yes
No

How did you hear about us?*

Agreement

Consent*

By checking this box I the Parent/Guardian and Child(ren) named below hereby agree to abide by the following terms during the time I am a volunteer for AEAR:

- Will treat all pets as a responsible and humane caregiver.

- Will remember to act appropriately whenever I am representing AEAR.

I have read and understand all of the statements above. Further, I understand that although AEAR takes reasonable care to screen the pets, it makes no guarantees relating to the pets health, behavior or actions. I understand that any contact my child(ren) have with a pet, is done at my own risk. I acknowledge that AEAR is not responsible for any property damage or personal injury suffered by me, members of my household, third parties or my other companion animals by any AEAR pet whom I or my come into contact with and I assume all liability for providing adequate controls to prevent such damage or injury.

I accept full responsibility for any and all expenses incurred during my child(ren) tenure as a representative for AEAR, except for those pre-approved by AEAR, if applicable. I understand that my child(ren) must conduct themselves in a mature way at all events and must adhere to all the proper handling of the animals in my care.

I have accurately completed this Volunteer Application and Agreement and I have read the above warnings and appreciate the risks involved in working with pets. I understand that AEAR cannot be responsible for the actions, behaviors, and/or medical condition of the pets that it seeks to rescue, and I agree to assume the risks implicit in working with pets which may have been abandoned, beaten or otherwise mistreated or abused, or who may suffer from an illness, condition or disease.

I understand that AEAR will determine the criteria for a child to become a member of the Youth Program

Acknowledgement*

I acknowledge that I understand that I must submit payment of $45 to complete this registration via the "Register and Pay" button that will be displayed after I submit this form.

Date*

Parent or Legal Guardian*

Bringing people and pets together through education, therapy, and rescue

Youth Program Registration & Payment

Youth Program Application & Agreement

Application

Agreement