Racine Zoo Slumber Safari 2026 Waiver

Racine Zoo Slumber Safari Waiver

Please fill out one waiver per participant attending. Participants may not attend until this form is filled out completely and signed by themselves or a parent/guardian if under 18 years old.
Name*

First NameLast Name
Please provide any information on any medical conditions, health problems, or medications that the staff should know in advance to best accomodate the needs of your group. If none, please write none.
Allergies:*
Please list any allergies the participant has. If there are none, please type none.
Physical or Mental Disabilities:*
Please list any disabilities the participant has. If there are none, please type none.
Prescribed Medications:*
Please list any prescribed medications the participant has. If there are none, please type none. Please note that Zoo Staff may not administer any medications.
Health Restrictions / Developmental Conditions:*
Please list any health restrictions or developmental conditions the participant has. If there are none, please type none.
I hereby give my consent for emergency medical care or treatment of myself/my child, to be used only if I am unable to respond or cannot be reached immediately.
Please select one of the options below.*
If you do not agree to the above statement, you may not participate in the Racine Zoo Slumber Safari program.
Photo Release and Hold Harmless Statement
I grant permission to the Racine Zoo, its agents, and its employees the irrevocable andunrestricted right to produce photographs and video taken of my child, myself, and members ofmy family while at Racine Zoo Camp for any lawful purpose including publication, promotion,illustration, advertising, trade, or historical archive in any manner or in any medium. I herebyrelease the Racine Zoo and its legal representatives from liability for any violation or claimsrelating to said images or video. Furthermore, I grant permission to use the statements of mychild, myself, or my family members given during an interview or evaluation with or without myname for the purpose of advertising and publicity without restriction to time limit or geographicarea. I waive my right, my child’s rights, and my family’s rights to any and all compensationstemming from the use of these materials.
Please select one of the options below.*
I agree that my or my child's participation in activities associated with Racine Zoo Slumber Safaris or programs (the activities) while on the Racine Zoo premises is voluntary and at the sole risk of the undersigned. In consideration for my child being permitted to access and utilize the Zoo premises, facilities and equipment the undersigned agrees for themselves and their heirs and assigns to releaseand discharge the Zoo and the City of Racine from any claim, demand, injury, cost, or liability, whether resulting from the negligence of the Zoo and/or the City of Racine or otherwise arisingout of or resulting from or incident to my child's participation in the activities or the use of thepremises, or any of its equipmentor facilities in connection with the activities.
Please select one of the options below.*
If you do not agree to the above statement, you may not participate in the Racine Zoo Slumber Safari program.
Signature of Self or Parent/Guardian*
Date*

MonthDayYear
Date
Should be Empty:

Racine Zoo Slumber Safari Waiver

Photo Release and Hold Harmless Statement