Memory Mews Consent

Memory Mews Consent Form

Name(Required)
General Release(Required)
I, the participant or designated agent of the participant I am registering (“participant”) hereby consent to the participant, named above, partaking in the Humane Society of Broward County’s (HSBC) Memory Mews program. I understand that the participant I am registering may have direct contact with domestic and exotic animals. I further understand that the behavior of domestic and exotic animals is sometimes unpredictable and that some domestic and exotic animals are capable of inflicting serious personal injury. The undersigned, for himself or herself and on behalf of said participant, does hereby absolutely and unconditionally release, indemnify, hold harmless and forever discharge HSBC, its officers, directors, employees, successors, assigns, agents, and volunteers, and each of them, from and against any and all claims, demands, obligations and liabilities of every nature and kind whatsoever, including, without limitation, negligence, occurring during, directly or indirectly resulting from or arising out of participant’s participation in Memory Mews. As to matters covered hereby, this release shall extinguish all claims, demands and rights which the undersigned or the participant (and/or each of their heirs, successors, and assigns) has or may ever have against the parties released hereby, or any of them, for injuries, costs or damages to the minor occurring during, directly or indirectly resulting from or arising out of minor’s participation in HSBC’s Memory Mews whether such injuries, costs or damages are known or unknown, foreseen or unforeseen, ascertainable or unascertainable.
Allergen Release(Required)
Please note that participants may encounter a number of common potential allergens during a Memory Mews session, including dog, cat, and rabbit dander. Due to the nature of our work, we cannot guarantee an environment free from any allergens.