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CAMPER PICK-UP AND EMERGENCY
FORM
· Camp starts
at 10:00am and goes until 3:00pm each day.
· We will
only release campers to people listed on the form at the bottom of this
page.
· If a camper
needs to be picked up early, please send written notice with your camper
and alert his/her counselor. Go to the main office and have them
call the camp staff.
·
Morning drop-off,
as well as afternoon pick-up, will be at the Natural Resource Center in
the special events area. You must sign your child
in and out.
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CAMPER PICK-UP AND EMERGENCY FORM
TO BE COMPLETED BY PARENT OR LEGAL
GUARDIAN
PLEASE SEND THIS PORTION BACK AT
LEAST ONE WEEK PRIOR TO CAMP!
Camper Name:
_____________________________________________________
Name(s) of people authorized to pick up
this camper:
(1) _____________________________
(2) ____________________________
(We will only send this camper home with people listed on this form, unless
we are given written notice of change)
I, (parent / legal guardian)_________________________________,
the
undersigned,
give my permission
for(childs name)______________________________________
to participate in Winter
Safari Science Camp at Wildlife Safari, and have indicated any restrictions
in activity, allergies, medical conditions, and medications on the form
below. I also authorize Wildlife Safari and its employees or volunteers
to secure any and all necessary medical services for my child in the event
of an accident or illness. Further, I agree to be solely responsible
for the payment of those services. I authorize the image of my child
or his/her likeness to be represented in Wildlife Safaris future promotion
of this and other education programs in all forms of media.
Allergies (food, drugs, insects, etc.)
__________________________________________________________________________
Medical conditions or activity restrictions__________________________________
Medications (name, dosage, reason) ____________________________________
Insurance carrier _________________________
Group or ID# ______________
In case of emergency, please notify ______________________________________
Phone ______________ Alternate contact
_________________ Phone _______
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