Critter Barn

Accommodating Programming Member Registration


What's your email address?

Your information


Required fields are marked with an asterisk (*).
Volunteer First Name *
Volunteer Last Name *
Parent/Guardian First Name
Parent/Guardian Last Name
Parent/Guardian Phone Number
Emergency Contact Name *
Emergency Phone # *

For example, 123-456-7890
Address 1 *
City *
State *
Zip *
I have Health Insurance *
Name of Health Insurance *
Policy Number / Insurance ID Number *
Insurance Carrier/Phone Number *
Physician's Name *
Physician's Phone *
Will your volunteer have medications at the farm? *
If yes, please explain medication details:
Will your volunteer have an epi-pen? *
Epi-pen instructions:
Is your volunteer allergic to any medications or food? *
Please explain any allergies:
Please list any special accommodations:
Today's Date *

Disclaimer

GENERAL WAIVER

My child/children is/are attending and/or volunteering at the Critter Barn, a Michigan non-profit organization located at 2950 80th Avenue, Zeeland, Michigan 49464 with my consent. The Critter Barn administrators are authorized to arrange for emergency care as needed. I hereby exempt, release and hold harmless the Critter Barn and its’ volunteers from any and all liability claims or causes of action whatsoever arising out of, or which may result from the above child/children attending and/or volunteering at the Critter Barn. In signing this form I acknowledge that Critter Barn may, from time to time, use photos of including me and/or my child or guest, for promotional purposes. I am the parent/legal guardian of the above-named child/children. I have read and agree with all the above. By typing my name in the box I am authorizing


TALENT/INTERVIEW/VIDEO/PHOTOGRAPHY GENERAL RELEASE


Regarding having my photo taken or being in background shots of other photographs while on the property of the Critter Barn, I hereby, on behalf of myself, my heirs, executors and administrators, sell, grant, assign and deliver to The Critter Barn, its subsidiaries and affiliated companies, its successors, agents, licensees and assigns, and those acting under its permission or upon its authority, the exclusive right to own, copyright, use, reproduce, publish, license, assign, display, retouch and/or alter at any time and in any media, now known or hereafter developed for any lawful purpose, photographic and/or audio visual materials including my image and any recording of my voice, and to make any changes and/or additions thereto, or derivative works there from, for reproduction and/or publication in conjunction with either my own or fictitious names, testimonial copy, or otherwise. I specifically waive and surrender any claim which I may now have or hereafter have that use of the work referenced above would constitute an invasion of my privacy. I release The Critter Barn of any compensation or financial claim by me as a result of these recorded images.

I hereby warrant that I am of legal age and have every right to contract in my own name, or that I am the parent, legal guardian, or authorized agent of the person whose name appears below. I state further that I have read this agreement, prior to its execution, and that I am fully familiar with the content thereof.

This contract constitutes the entire agreement between The Critter Barn and me and supersedes all other agreements, statements, representations, and understandings, whether made verbally or in writing, concerning the subject matter of this agreement and may only be modified in writing signed by The Critter Barn.

MY SIGNATURE BELOW AND IT INDICATES THAT I HAVE READ THIS ENTIRE DOCUMENT, UNDERSTAND IT COMPLETELY, AND AGREE TO BE BOUND BY ITS TERMS.