Minor Child Guest Registration

In the past we were able to take our children’s friends with us anywhere their parents agreed to let them go with us. In this day and age of Litigation, that is no longer as simple as it once was. To that end we have a form that must be used if you, as a member, want to bring along a friend of your child’s. We ask that this form be Notarized as to be a legal document allowing you to bring said child along to visit our small patch of woods.

Statement of Responsibility Regarding Minor Child

Visiting Raven-Wolf Nature Sanctuary

 

I, ___________________________________________

(print legal name)

do authorize the person or persons listed below to execute the responsibilities of temporary guardianship over my child

______________________________________________

(print child’s legal name)

while in attendance at Raven-Wolf Nature Sanctuary on the dates of _____________________.

These responsibilities include but may not be limited to:

obtaining medical or dental attention in any case of illness or emergency need, administering medication or first aid, establishing and maintaining behavior guidelines, asserting discipline as needed, providing adult supervision, and administering permission for activities.

Adult or adults given and accepting of these responsibilities:

Legal Name: _____________________________________________

Legal Name: _____________________________________________

Legal Name: _____________________________________________

I do certify that I will not hold any named above as guardians, nor any of Raven-Wolf Nature Sanctuary Staff, Representatives, or Associates liable for my child’s actions, injury, or illness should any such result in harm or damage to my child, to others, or to any property.

Legal Name: ___________________________

Signature: ______________________________

**************************************************************

CERTIFICATE OF ACKNOWLEDGEMENT OF NOTARY PUBLIC

State of ____________________

County of ________________________

This document was acknowledged before me on _____________________ (date)

by_________________________________________ (name of principal).

Signature of Notarial Official: _______________________________

Notary Seal, if any:

 

 

Notary Public for the State of: _______________________________

My Commission expires: ___________________________________

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