Simcoe and District Humane Society

Participant's Name

Is Participant Over 16?

Nes
No

If Participant is under 16 please give Parent/Guardian's Name

Email

Phone

Pet's Name who will be participating

Pet is a .....

Dog
Cat
Cockatiel, Chicken, or other bird
Farm Animal
Reptile or Amphibian
Other type of pet

If other please tell us what your pet is

User Agreement

By continuing, you agree to our Privacy Policy and Terms of Service

Thank you for helping us help those who cannot help themselves!

WAIVER

I hereby release and discharge Simcoe and District Humane Society, Norfolk County, Downtown Simcoe BIA and all other participating distributors/sponsors from any claims, injuries, losses or liabilities suffered or incurred as a result of my participation or the participation of the participant named below if he/she is under 18 years of age in the above named event.

All participants and/or parent or guardian must sign this waiver

All animals BIG and small of all kinds welcome!

For the safety of all pets and people, but must be leashed, contained or controlled

Signature (your name entered below will act as your signature)