Community Service Name of Parent/Legal Guardian(Required) First Last Relationship(Required)MotherFatherLegal GuardianPhone(Required)Email(Required) Name of Participant(Required) First Last Age of Participant(Required)121314151617Second Participant (if applicable) First Last Age of second Participant (if applicable)121314151617Third Participant (if applicable) First Last Age of third Participant (if applicable)121314151617Emergency contact (different to parent/legal guardian)(Required) Name Contact Number Consent(Required) I hereby acknowledge and understand that the Society for the Prevention of Cruelty to Animals (“the SPCA”) and its employees and authorised agents will take reasonable precautions during my minor child’s visit to their premises, and during the period that he/she renders voluntary work for them, or on their behalf, but do not accept any liability for any claims which may arise from any cause whatsoever and for the duration of this period will be subject to the terms and conditions hereunder.1. I/We acknowledge that during the course of my child’s work he/she will be working with animals and that such work with the animals will be solely and exclusively at my own risk and/or that of the minor child; and 2. I/We undertake to ensure that the minor child will at all times obey, immediately and without query, any order, command, demand or request that may be made of him/her/me at any stage by any employee or authorised agent of the SPCA; and 3. I/We understand that the purpose of such order, command, or request will be made for the purpose of ensuring the minor child’s personal safety and the safety of others in whose command he/she may be; and 4. I/We acknowledge and accept that the SPCA is exempted from any liability in respect of the minor child’s death or bodily injury or damage to any of his/her/my/our property from whatever cause arising; and 5. I/We acknowledge and accept that the SPCA is exempted from any liability in respect of the minor child’s death or bodily injury or damage to any of his/her/my/our property as a result of his/her failure to comply immediately with any order, command, demand or request of any employee or authorised agent of the SPCA; and 6. I/We hereby indemnify the SPCA and any of the employees or agents, whether in their capacity as such or in their personal capacity against any claim by myself/ourselves, the minor child, his/her/my/our executors, administrators, heirs or assigns or by anyone else claiming through him/her/me/us or on his/her/my/our behalf in respect of any claim arising from his/her death or bodily injury or damage to any of his/her/my/our property from whatever cause arising; and 7. I/We hereby indemnify the SPCA and any of the employees or authorised agents, whether in their capacity as such or in their personal capacity against any loss or damage from any cause whatsoever, which may be sustained as a result of the minor child’s failure to comply immediately with any order, command, demand, or request of any employee or authorised agent of the SPCA. I/We hereby acknowledge that I/we have read the contents of this document and that I/we have been afforded the opportunity to raise questions in regard to any aspect contained herein and I/we acknowledge that I/we am/are bound by the terms and conditions as set out above, and that I/we and/or the minor child bind myself/ourselves/himself/herself by affixing my/our signature(s) to this document.R100 per participant Quantity(Required) Price: R100.00 Quantity Total
