CONSENT AGREEMENT AUTHORIZATION AND RELEASE
This Consent Agreement, Authorization and Release must be read and signed in order for your child and family to receive services through Tu Nidito.
Click the plus sign to the right of your first entry to add more columns.
To communicate Tu Nidito’s mission, we sometimes want to use quotations, photos, video, stories or artwork from the group participants for display boards, brochures, grant applications, newsletters or trainings. The last name of the participant is never spoken or printed. Participation is voluntary.
We consent for the above named family members to interact with a pet therapy dog at Tu Nidito. If there is an allergy or fear of dogs or if there is a cultural barrier for interacting with dogs or if for any other reason you would prefer not to have interaction with a therapy dog, please check no.
I expressly understand and agree that this Release is intended to be as broad and inclusive as permitted by law, and that the Release shall be governed by and interpreted in accordance with the laws of the State of Arizona. I agree that in the event that any clause or provision of this Release shall be held to be invalid by any court of competent jurisdiction, the invalidity of such clause or provision shall not otherwise affect the remaining provisions of this Release.
By signing below, I acknowledge that I have read and understand this Release, and agree to its provisions. I further represent that I am an authorized signor for the family and family members listed above.