Camp K9 Registration Form! - Dorothy O`Connor Pet Adoption Center

Camp K9 is for kids 10-15 years of age. Your child will experience specific training techniques
to use on a current or future pet. Campers are encouraged to train our shelter dogs, increasing
their chances for adoption. Your child is invited to bring their family dog, prior approval
required by the Director. Safety of all campers and dogs is our priority.
Register early, space is limited.
Call, fax, or email your registration today. Make a difference one pet at a time!
CAMP K9 IS A FUN & EDUCATIONAL EXPERIENCE!
CAMP K9 PROGRAM:
•
•
•
•
•
CAMPS INCLUDE:
Canine body language
Basic dog training and agility fun
Learning about pets and pet responsibility
Field trip to a Veterinary Clinic (Wednesday)
Take a behind the scenes tour to view our
mission in action
CAMP SESSIONS:
Monday-Thursday • 9:00am-12:00pm
June 15-18
June 22-25
July 6-9
July 13-16
$150 (non-refundable) per child; per camp session
Please no dropoffs before 8:30 am
Camps will be held in DOCPAC’s
Marsha Shanklin Education Building
Camp schedule is subject to change.
• Dog Treats
• Shelter dog or camper’s family dog (DOCPAC
approved) with current rabies certificate
• Camp K9 T-shirt
• Camp dog photo
• Snacks
• Water
• Fun, educational, hands-on experience
• Treat bags
ATTIRE:
•
•
•
•
Cool, comfortable clothing
Tennis Shoes (no exceptions)
Sunscreen
Optional: Water bottle with child’s name
written on the bottle (no soft drinks)
Make checks payable to:
DOCPAC, 135 Progress Dr., Victoria, Tx 77905
www.docpac.net • (361) 575-8573 • fax: (361) 575-8575 • petadoptions@docpac.net
CAMPER INFORMATION
Check the desired session to attend: ($150 per session)
June 15-18
June 22-25
July 6-9
July 13-16
Child’s Name: _________________________________________________________________________Age:__________________
Parent’s Name: ______________________________________________________________________________________________
Daytime Phone: ___________________________________Cell Phone: ________________________________________________
Address: _____________________________________________City:_________________________ST_________Zip:___________
Email Address:_______________________________________________________________________________________________
Please list any medical or special needs, allergies or limitations:
____________________________________________________________________________________________________________
Is your child allergic to ANY animals?_______________
My child will train:
Does your child have peanut allergies?_______________
Shelter dog (or)
Family dog
Two Emergency Contacts/Relationship:
Name:________________________________________________
Name:________________________________________________
Relationship:__________________________________________
Relationship:__________________________________________
Phone #1: ___________________________________________
Phone #1: ___________________________________________
Phone #2: ___________________________________________
Phone #2: ___________________________________________
T-Shirt Size: (Please Circle One)
Youth:
Medium
Large
Adult:
Small
Medium
Large
X-Large
Legal Information
In consideration of being allowed to participate in the DOCPAC Camp K9, the undersigned, on his or her own behalf, and/or on behalf
of the participant(s) identified below, acknowledges, appreciates, and agrees to the following conditions:
I,___________________________________________________the parent/legal guardian of_________________________________________ the participant(s), do
recognize that as part of the participant(s)’ attendance at the day camp, he or she will be in contact with and may be allowed to hold and pet animals. I
understand there is a chance that the participant(s) may contract a disease or illness in handling the animals. I also understand that there is a chance
that the participants may sustain a scratch or bite while handling the animals. I understand that the above is illustrative of the types of risks involved in
participating with day camp, but is not a complete list of possible risks. I, on behalf of myself and the participants, knowingly and freely assume all such
risks, both known and unknown, even if arising from the negligence of others; and, by signing my name below, I, for myself and the participant(s)
do hereby absolutely and unconditionally release and discharge the Dorothy O’Connor Pet Adoption Center including its employees, successors,
assigns, directors, officers, and agents, from and against any and all claims, obligations and liabilities, of every nature and kind whatsoever, relating to or
arising out of participant(s)’ participation with the Dorothy O’Connor Pet Adoption Center’s Day Camp. In case of injury to my child, I request the Dorothy
O’Connor Pet Adoption Center to contact me. If the Dorothy O’Connor Pet Adoption Center is unable to reach me or the emergency contact, I authorize
the Dorothy O’Connor Pet Adoption Center to make whatever arrangements deemed necessary.
I certify that I am the above child’s legal parent or legal guardian:
YES
NO
I authorize the Dorothy O’Connor Pet Adoption Center to use my child’s name, photograph, and video image for public relations both in
their newsletter, facebook and on the website www.docpac.net:
YES
NO
___________________________________________________________________________
Parent/Guardian’s Signature
______________________________________
Date