P.A.L.S. Application Form

NOTE: This application is ONLY for the P.A.L.S. Club program.

For General Volunteer opportunities, please call 440-338-4819 x 49.

Please complete this application form if you are interested in having your child become a member of the Pet Advocacy, Learning and Service club at Rescue Village. Once you complete the form, click the submit button at the bottom and you will be contacted.

Child's name and address

Child's Date of Birth and Age

Emergency Contact

Parent/Guardian's Name

Peanut Allergies? Any other allergies?

Club Membership Fee -- Method of payment

1) Check (mailed or in-person drop off)

2) Credit Card: Name, Card Number, Expiration Date, V-code, Billing Address

3) Cash (mailed or in-person drop off)

Liability Waiver

Geauga Humane Society Tetanus Waiver

TETANUS is a bacterial disease that affects the nervous system. It is contracted through a cut or wound that becomes contaminated with tetanus bacteria. A Td booster shot is recommended every 10 years. If you experience any break in the skin, (cut, scratch, bite, etc.) you must immediately report the incident to your health care provider. We strongly recommend that you to be vaccinated against tetanus and to consult your physician concerning the risks of tetanus.

Geauga Humane Society Liability Waiver

I do hereby declare myself physically able to participate in the volunteer activities for which I have applied. I am fully aware that there are physical risks inherent in the care of animals and related activities performed by GHS. In consideration of being permitted by GHS to participate in volunteer activities, both at Rescue Village and at off-site events, I hereby release, waive, discharge, and covenant not to hold liable or sue GHS, its board of directors, employees, volunteers, sponsors, contributors, or agents (“released parties”) from all liabilities to my personal representatives, assigns, heirs, and next of kin, for an and all loss or damage, and any claim or demand therefore account or injury to the person or property of the undersigned, whether caused by the negligence of the released party or otherwise.

I have carefully read this agreement and fully understand its contents. I am aware that this is a release of liability and a contract between my self and Geauga Humane Society. I authorize Geauga Humane Society to verify the information by any reasonable means if they deem necessary.