Dinotots Summer Club Booking Form

Childs Name*

First NameLast Name

Date of Birth*

MonthDayYear

Address*

Street Address

Street Address Line 2

City

Post Code

Parent/Guardian Information

Name*

First NameLast Name

Contact Number*

E-mail*

example@example.com

Emergency Information

Emergency Contact's Name*

First NameLast Name

Relationship*

Emergency Contact's Number*

Area CodePhone Number

If your child is unknown to Dinotots (has not attended any setting previously) does your child have any allergies, illness, or medical conditions? If yes, please describe.

Is your child prescribed an inhaler? If yes, please explain any instructions.

Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Dinotots during the days selected below. In exchange for the acceptance of said child’s candidacy by Dinotots, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Dinotots and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected sessions.

In case of injury to said child, I hereby waive all claims against Dinotots including all employees and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event, I also understand that there is a risk of being injured that is inherent in all summer club activities

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

BY SIGNING I ALSO ACKNOWLEDGE THAT I HAVE READ, AND ACCEPT, DINOTOTS TERMS AND CONDITIONS AND AGREE TO BE BOUND BY THEM

I ALSO ACCEPT THAT ALL FEES PAID ARE NON-REFUNDABLE AND I MUST ARRIVE BY THE AGREED TIME. BOOKINGS ARE NOT FLEXIBLE, NON-TRANSFERABLE AND CANNOT BE SWAPPED.

Date

Signature

Select the days and length of time you wish to book your child in to Summer Club. Although it is an hourly charge we do require, for the child's enjoyment, a booking of at least 2 hours per selected day. BOOK A FULL DAY (9 or 10 hours) AND GET IT VIRTUALLY AT THE PRICE OF 8!

Payment Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Summer Club Registration

Child's Information