Animal Skills 3 day Program
Referred by ( teacher, school, other)
First name
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Surname
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How old are you
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Date
Tell us why you would like to be a part of our animal skills program
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Address
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email address, (please note Government emails may not receive responses.)
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I understand that during this program we will be working with living creatures who deserve my respect as well as instructors and other people who are available to help me and the dogs in our care. I will respect them all and do my best to follow instructions and to care properly for the animals.
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No
Yes
I understand that the dogs may be frightened by loud or obnoxious behaviour and i will do my best to behave well while i am around the dogs so that they will enjoy the program as well
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No
Yes
Do you have any allergies, including special food requirements and animal allergies
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No
Yes
If allergic to food what food are you allergic to?
If yes to allergies what are you allergic to?
If you answered yes to health issues please list your health concerns so that we can ensure that you are cared for during this program
Do you suffer from any health issues that may cause a problem during this program?
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No
Yes
emergency contact name and phone number
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I understand that PAWS Darwin and their team will take every care to support me through out this program and that should an accident occur that I will not hold them liable (blame them ) and that i will provide helpful information if i need support.
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No
Yes
I declare that all information is correct at the time of signing this form.
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No
Yes
Photos may be taken during the course of our program, these photos may be used for marketing and for grant acquittals, i am aware of this and give my permission for any photos to be used.
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No
Yes
Does your Guardian approve and what is their name
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Guardian to please sign
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Clear