Zoo Day Camp Policies And Release Form (Page 2 of 2) in pdf

ZOO DAY CAMP POLICIES AND RELEASE FORM

Hold Harmless, Behavior Policy, Photo Release, and

Confidential Medical/ Behavioral Information and Accommodation Form

Dear Parent/ Guardian,

All children are welcome at San Diego Zoo programs. Please include any necessary medical or behavioral

information that will help us provide a safe and fun learning environment for your child. This includes food and

other allergies. This information will be used only as needed and solely by the Zoo. This is a confidential form.

This form must be completed and signed in order for your child to participate in a zoo program.

Name of Participant / Camper / Your child: __________________________________________

Grade level and age of participant:_________________________________________________

Name of Camp program enrolled in:________________________________________________

Dates of participation:____________________________________________________________

Name of Parent/ Guardian (please print):____________________________________________

Parent phone number during program:_____________________________________________

EMERGENCY CONTACTS (if we cannot reach the parent/ guardian above):

NAME

PHONE # DURING PROGRAM

RELATIONSHIP TO CAMPER

Emergency Treatment Authorization

I hereby authorize any licensed physician, emergency medical technician, paramedics, nurses, or hospital or

other medical or health care facility or provider (“Medical Provider”) to provide medical care to me or the minor

participant for any injury and/or condition that occurs, manifests or arises at any camp or program activities or

related activities. I further authorize any Medical Provider to perform all procedures or services deemed

medically advisable to treat or relieve, or to attempt to treat or relieve any illness, injury, and/or condition.

I acknowledge that there is a possibility of complications and unforeseen consequences in any medical

treatment, and I knowingly and voluntarily agree to assume such risk for and on behalf of myself and/or said

minor. I acknowledge that no warranty is being made as to the result of medical treatment. I agree that I, or

the minor participant is capable of participating in camp or program activities except as otherwise noted below.

In addition, I agree to the terms of the hold harmless, behavior policy and photo release on page 1.

Medical or behavioral information that will help us provide a safe and fun learning environment for

Your child (if there are none that you are aware of, please indicate by writing NONE).

Signature of parent/guardian :_________________________________

Date: ________________

Page 2 of 2: Updated 1/9/2014

Zoo Day Camp Policies And Release Form Page 2