|
Registration
Information: |
|
|
| Parent
First Name: |
*
|
Child
First Name: |
*
|
| Parent
Last Name: |
*
|
Child
Last Name: |
*
|
| Mailing
Address: |
*
|
|
|
| City: |
*
|
|
|
| State: |
*
|
|
|
| Zip: |
*
|
|
|
| Current
Age of Child: |
*
|
Age
on Date of Camp: |
*
|
| Home
Phone: |
*
|
Work
Phone: |
|
| Cell
Phone: |
|
|
|
|
Email Address: |
* |
(for emailed camp confirmation
letter) |
|
Are you a Current Passholder?: |
Yes
No |
|
|
|
If yes, Passholder Number: |
|
|
|
To receive passholder
discount, you must submit your pass number. We will check to verify
that you are a current passholder. |
|
|
|
|
| List
the Names of the person(s) authorized to pickup your child: |
*
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Emergency Contact
Info: |
|
|
|
In case of emergency, please
notify (if you cannot be reached): |
|
|
| Name: |
*
|
|
|
| Relationship: |
*
|
|
|
| Phone: |
*
|
|
|
| |
|
|
|
|
Physician to be called in an
emergency: |
|
|
| Name: |
*
|
|
|
| Phone: |
*
|
|
|
|
|
|
|
|
Medical Information: |
|
|
|
Please
complete the following. If not applicable, please type
"none". |
|
Physical limitations: |
*
|
|
* Note: We
welcome attendees of all physical abilities. The above
information is to assist us with program and staff planning. |
|
Allergies (however minor): |
*
|
|
Medications
(please describe): |
*
|
|
* Note:
All medications brought with the child must be mentioned to staff
upon arrival. Zoo staff will not administer medications. |
| Dietary
Restrictions: |
*
|
| Other
Important information: |
|
|
|
|
|
|
|
|
|
Zoo
Release of Liability
I, the parent or legal guardian of the
camp participant, do agree to assume all risk associated with
participation in the Alaska Zoo Adventure Camps. I
agree to advance release of the Alaska Zoo organization, board,
staff and volunteers from any and all liability for property damage,
personal injury or death.
I have
read and agree to the release of liability policy. By accepting
these terms through on-line submission, I am agreeing to the terms
of this release.
I Agree
I Disagree
|
|
|
|
|
|
|
Payment
Information
Your camp spot is reserved upon submission of
this completed form, however we cannot process payment online at
this time. Please submit your payment in the following ways:
If you
wish to pay by CREDIT CARD, call your payment in to our zoo
office at 346-2858
If you wish to pay by CASH or CHECK, mail your payment to the zoo
at:
The Alaska Zoo c/o Camps
4731 O'Malley Road
Anchorage, AK 99507
You may also drop off your payment with a copy of the
completed form at admissions at the above location. Payment will not
be processed at admissions. Receipt sent by mail upon request.
Payments
must be submitted to the zoo office within 5 Business Days of
submitting this form. |
|
Payment
Method: |
|
Your confirming Email
will Provide a Total of the Amount Due |
| |
|
|
|
|
Refund
Policy
Cancellations must be made in
advance of 5
business days before the program date for refunds.
Those made less than 5 business days before a program will result in
no refund. If a program is cancelled due to enrollment, a
full refund will be given.
I have
read and agree to the payment and refund policy terms:
I Agree
I Disagree
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|