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Zoo Camp Registration
WDD Design
2024-02-01T11:55:13-05:00
Zoo Camp Registration
Camp Dates
(Required)
June 18–21 FULL
June 25–28 (ages 7-11)
July 9-12 (ages 7-11)
July 16-19
Select One
Child’s Name
(Required)
First
Last
Gender
(Required)
Male
Female
Age
(Required)
Please enter a number from
7
to
15
.
Shirt Size
(Required)
YS
YM
YL
S
M
L
XL
Select One
Address
(Required)
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Contact Information
Parent/Guardian
(Required)
First Name
Last Name
Phone
(Required)
Email
(Required)
Emergency Contact Information & Alternate Pickup/Release
Email
(Required)
Emergency Contact
(Required)
First Name
Last Name
Phone
(Required)
Email
(Required)
Relation to Child
(Required)
Additional Relations
Please list those people including in addition to parents/guardians who are permitted to pick up your child:
Name #1
Name #2
Name #3
Medical Release Information
Please tell us anything you feel we should know about your child that will help us take care of him/her this week.
Is your child allergic to any food or medication?
Yes
No
If yes, explain:
Medical Release Consent
(Required)
I agree to the consent
The above-listed information aims to ensure medical personnel have details of any medical issues that may interfere with or alter treatment.
I understand that I will be notified in the case of a medical emergency involving my child. If I cannot be reached, I authorize the calling of a doctor and the provision of necessary medical services if my child is injured or becomes ill.
Accident Release & Financial Responsibility waiver
(Required)
I agree to the waiver
By registering for this Emerald Coast Zoo program, I understand the educational programs and encounters provided by the Emerald Coast Zoo have an inherent danger involved with my or my child’s participation in these programs, including the risk of personal and bodily injury and damage to my or my child’s property while participating in these programs. I further understand and acknowledge that participants in such programs are not covered under the Emerald Coast Zoo's insurance. I hereby give my consent and authorize and grant permission to representatives of the Emerald Coast Zoo to administer first aid and/or to obtain emergency medical care or treatment from any licensed physician or hospital and/or medical clinic at my expense, should I or my child become ill or injured while participating in any Emerald Coast Zoo activities. I freely and voluntarily execute this release and, with such knowledge, assume the risk of personal injury and/or property loss arising from or in any way connected with my or my child’s participation in any educational program(s) offered by the Emerald Coast Zoo.
I hereby release and forever discharge the Emerald Coast Zoo and any and all agents of the Emerald Coast Zoo from any and all liability, claim, cause or action, demand, or damages from injury, damage, or loss of any kind to my child and my property as a result of my or my child’s participation in the education programs and encounters of the Emerald Coast Zoo. I further waive, release, absolve, and agree to indemnify and hold the Emerald Coast Zoo harmless due to my or my child’s participation in any program sponsored by the Emerald Coast Zoo. I understand that should I or my child become a disruptive force during the educational program or encounter, the instructor may choose to release him/her from the situation.
Photo Release Waiver
(Required)
I agree to the waiver
I permit the Emerald Coast Zoo and its representatives to take and use my or my child(ren)’s picture and/or quotes for any purpose, including advertising and publicity through social media, radio, and television. I further agree that all property rights in and to any advertising or publicity materials, films, or recordings containing my picture or quotes or my child(ren) are the sole and exclusive property of the Emerald Coast Zoo.
Camper Fee
(Required)
Price:
Camper registration is only complete once the payment is made. Click the payment button on the Zoo Camp Page after submitting this registration form.
Name
(Required)
Please provide the name of the person making the payment to link payment and forms for camp registration.
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