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1. Child's Name (Required.)

If you are completing this form for more than one child please add their names. One form=all children registered

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2. Additional Children Registered (if you have more than one child attending Homeschool Classes please list them here)

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3. Parent/Gardian Name (Required.)

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4. Primary Phone # (Required.)

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5. Allergies/Limitations (write none if none) (Required.)

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6. Emergency Contact, phone, relation to child (Required.)

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7. Secondary Phone #

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8. Contact Email (Required.)

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9. County child resides in (Required.)

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10. How did you hear about us? (check all that apply)

Waiver Form (Medical, Photo, Liability)
I understand and acknowledge that while participating in the educational programs provided by the Central Florida Zoological Society, Inc. (CFZS) that participants are not covered under insurance of CFZS and that the CFZS would not allow my participation in these programs absent my signing this release. I therefore 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 participation in any educational programs offered by the CFZS.

I authorize and grant permission to the representative of CFZS to treat minor injuries including scrapes, small cuts, splinters, and insect bites.

I authorize and grant permission to the representative of CFZS to obtain medical care from any licensed physician or hospital and/or medical clinic should I become ill or injured while participating in educational activities when neither parent or guardian is available to grant authorization for emergency treatment. In addition, upon my request, I authorize a representative of CFZS to administer any medications provided by me for my benefit.

I hereby release and forever discharge CFZS and any and all agents of CFZS from any liability, claim, cause of actions, demand or damages from injury or damages of any kind to me or my property as a result of my participation in the educational programs. I understand that should I become a disruptive force during the educational program that the instructor may choose to release me from the program without tuition refund for un-used days. I also understand that this is an education facility and cannot be claimed as day care on my taxes.

I understand that any photos taken of my child during CFZS education programs may be used in publication to promote educational programs.

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11. By submitting, I certify that I have reviewed the Accident Release, Financial Responsibility Waiver, and Photo Release. (Required.)

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12. Enter date (Required.)

Date

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13. Signature of Parent/Guardian (Required.)

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