Children's Summer Camp, Birthday Party location

If you are human, leave this field blank.

Child Name *

Child Age *

Parent/Guardian Name *

Parent/Guardian Email *

Mailing Address *

Phone Number *

EMERGENCY CONTACT NAME & RELATIONSHIP TO FAMILY (If parent/guardian cannot be reached) *

EMERGENCY CONTACT PHONE NUMBER *

HEALTHY HISTORY (Explanation of any checked boxes above) *

List Any Medications that the Movie Goer is currently taking *

State or Territory in which the Child Resides:

Is this child exempt from any immunizations? No__ Yes__ *

Yes

If you answers YES to above question -- Please List the Immunizations they are exempt from.

Does the Movie Goer reside outside of the United States, a United States territory, or the District of Columbia *

Yes

IF YES to Question Above -- What Country Does the Child Reside?

Has the Movie Goer had any serious injuries and/or operations (please explain) *

HEALTHY INSURANCE (Please provide Company, Policy Number, Family Physician, Phone Number of Physician) *

EMERGENCY AUTHORIZATION (By checking the "I Agree" box, you have given permission to the Humane Society of Charles County and/or any contact person listed above authorization for treatment for your child in the event that we cannot reach you in an emergency) *

I Agree to Emergency Authorization

GENERAL RELEASE AGREEMENT: By Checking the “I Agree” box (you understand the following: FOR CONSIDERATION which is hereby given and received and acknowledged as sufficient between the parties, you hereby certify that you are the parent or legal guardian of (“Movie Goer Participant”) and you give your permission for him/her to participate in the Humane Society of Charles County, Inc. PJ Party Movie Night wherever said program occurs, including transportation from one location to another. Regarding participation in said program, you hereby release and discharge, for yourself and the Movie Goer Participant, and for your heirs, representatives, executors, administrators, successors and assigns and do hereby remise and release and forever discharge the Humane Society of Charles County, Inc. (“Releasee”), its officers, directors, agents, employees, independent contractors, parent and subsidiary corporations, and all other entities in any way related to Releasee, and all other persons however associated with Releasee, in any capacity, their heirs, executors, administrators, insurers, successors and assigns, and any and all other persons, firms, corporations, associations, of and from any and all causes of action, suits, rights, judgments, claims and demands of whatever kind, including, but not limited to any claims in law or in equity, known or unknown, which you and the Movie Goer Participant now have or may hereafter have, now or in the future, including any legal liability of Releasee arising from or by reason of any damage, compensatory or punitive, known or unknown, foreseen or unforeseen, which heretofore have been or which hereinafter may be sustained by your or the Movie Goer Participant, arising or any way relating to any and all claims and actions. This is effective the date of your registration, and the date that the “I Agree” box is checked. If you any reason you do not agree, please contact chanson@humanesocietycc.org *

I AGREE

PHOTO RELEASE By Checking the “I Agree” box, you hereby understand that you are the parent or legal guardian of the Camp Participant and hereby give the Humane Society of Charles County, Inc., your permission to take photos of him/her. You acknowledge that these photos are the property of the Humane Society of Charles County, Inc., and may be used by them for any purpose consistent with their mission statement, including but not limited to advertising and marketing. *

I AGREE

Clubs, Camps & Parties

DUE TO COVID-19 SOME OF THESE ACTIVITIES ARE CANCELLED UNTIL FURTHER NOTICE

PARTIES ARE BACK ON! LIMITED NUMBERS OUTDOOR ONLY TENT AVAILABLE

We Bring the Pets & Party to You! Introducing Mobile Party With The Pets

We bring the party to you!!! Introducing our new Mobile Birthday Parties

The Humane Society of Charles County is now offering “mobile birthday parties” — we bring the animals and educational fun to you!

We can also host your Birthday Party at the physical location of the shelter — you choose!

$200 for 10 guests includes:

PJ Party MOVIE NIGHTS SUSPENDED AT THIS TIME

PAWS CLUBS 2019-2020 SUSPENDED AT THIS TIME

Clubs are finished for the year. We hope to be able to come back next year!

2019-2020 PAWS CLUBS

We have a club for most ages!