|
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 CHECK, mail your payment to the zoo
at:
The Alaska Zoo c/o Camps
4731 O'Malley Road
Anchorage, AK 99507
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
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|