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.
I DO accept responsibility for any damage caused by my child to others, or property of Raven-Wolf up to an including payment to repair or replace any damaged equipment or reperations of physical or mental harm to others as sought after by them, not in connection to any Raven-Wolf staff, property or liasons.
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: ___________________________________
Raven-Wolf Nature Sanctuary 