Animal Program Registration Form

Animal Program Registration Form

Please fill out the form carefully for registration
Name*

First NameLast NameSuffix
School or Company
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
Phone Number*

Area CodePhone Number
Type of Group
Your date is not confirmed until you are contacted by our program coordinator to verify availability.
Date Requested - First Choice*

MonthDayYear
Date
Date Requested - Second Choice

MonthDayYear
Date
Time Requested

:HourMinutesAM/PM Option
Grade Level
Grade level or event age group if applicable.
Additional Comments
Terms and Conditions:

Client shall release, indemnify, and hold harmless, Safe Haven & Educational Adventures, Inc. its agents, officers, or employees from any and all responsibility or liability for any and all damages or injury of any kind or nature whatever to all persons, and to all property damage proximately caused by, incident to resulting from, arising out of occurring in connections with, the program provided to the client. The provisions of this section shall include any and all losses, damages, injuries, settlements, judgments, decrees, awards, fines, penalties, claims, costs and expenses.

Client accepts all responsibility for any injury to person (s) or property during the program period or resulting there from.

Failure by any individual or group to follow all applicable rules and regulations will cause for termination of your program.

Full payment is due upon completion of the program. We accept cash, check, credit card or Venmo.

One responsible adult must be present for every 30 children attending the presentation.
Signature*

Clear
I have read the information stated above and agree to the terms and conditions.
Should be Empty: