Kids Camps Required Info and Authorization

KIDS CAMP Required Camper Info & Authorization

Before your child/children attends camp, please complete this REQUIRED form.
IMPORTANT: This form must be completed and submitted BEFORE your child’s/children's scheduled camp date.

If we have not received this completed form prior to your child(ren)'s camp date, your child(ren) will not be permitted to attend or participate in camp activities.

Thank you for helping us provide a safe and enjoyable experience for all our campers!
NOTE: If you've registered more than one child, you'll be able to add them all by name in this one form.

Please be sure to provide accurate information and review each section carefully!
Your Name

First NameLast Name
Email
example@example.com
Please list the child(ren) you have registered for our Kids Camp
EMERGENCY CONTACTS

Please add at least one Emergency Contact other than yourself. You may add up to three.
Primary Emergency Contact

First NameLast Name
Primary Contact's Phone
Please enter a valid daytime phone number.Format: (000) 000-0000.
Secondary Emergency Contact

First NameLast Name
Secondary Contact's Phone
Please enter a valid daytime phone number.Format: (000) 000-0000.
AUTHORIZED PICK-UP PERSONS
You may add up to three authorized pick-up persons.

Please enter their name as it is shown on their government issued ID or driver's license.

These authorized pick-up person(s) are required to show their government issued ID or driver's license upon pick-up of your child(ren).

If there is no one other than yourself picking up the child(ren), enter your information.
1st Authorized Pick-up Person

First NameLast Name
1st Pick-up Person's Phone Number
Please enter a valid daytime phone number.Format: (000) 000-0000.
1st Person's Relationship to Camper
2nd Authorized Pick-up Person

First NameLast Name
2nd Pick-up Person's Phone Number
Please enter a valid daytime phone number.Format: (000) 000-0000.
2nd Person's Relationship to Camper
3rd Authorized Pick-up Person
example@example.com
3rd Pick-up Person's Phone Number
Please enter a valid daytime phone number.Format: (000) 000-0000.
3rd Person's Relationship to Camper
HELP US OUT

How did you hear about our Kids' Camps? Your answer helps us know where to focus our advertising and share future camp opportunities with more families!
Check all that apply

Other
Can you tell us some more details about that?
Where? When? Specifics help us out tremendously!
ACKNOWLEDGMENT & ASSUMPTION OF RISK
By submitting this completed "Kids Camps Required Info & Authorization" form, I understand that I assume the risks of injury or contraction of a zoonotic disease and losses of property associated with this Education Kids' Camp at Rolling Hills Zoo - includes Spring Break Kids' Camps, Summer Kids' Camps, Winter Kids' Camps.

I agree to release Rolling Hills Zoo, its Board of Directors, its officers, and the Zoo or Museum employees from liability for death and or any and all injuries or illnesses that may occur to my camper or property in areas that are not open to the public, except injuries caused exclusively by the negligence of the Zoo or Museum.
GIFT OF RIGHT OF PUBLICITY
I give, grant, and convey to the Rolling Hills Zoo its successors, agents, and assigns, without compensation to me or my child(ren) from any party, the absolute right and unrestricted permission to copyright and/or use and/or publish (1) my child’s/children's name, (2) my child’s/children's image or likeness on video, and (3) photographic pictures or portraits of my child(ren) or in which they may be included, in whole or in part, on reproductions in color or in black and white, made through any media, including social media, in connection with photos or video taken of my child(ren) at Rolling Hills Zoo for any purpose whatsoever, including but not limited to the promotion of Rolling Hills Zoo.

I further waive any right that I may have to inspect or approve the finished product. The video and photos will be Rolling Hills Zoo’s sole property.

I have read the foregoing. I also understand that this gift is binding on my heirs, successors, and assigns. I am over eighteen (18) years of age.
Do you agree and give permission?
Please upload a recent photo of your child/children to help our team identify them and ensure they are excluded from any photos or videos taken during camp, as requested.

Cancelof
Is there any other information you feel would be important for us to know about your camper(s)?
Should be Empty:

KIDS CAMP Required Camper Info & Authorization

EMERGENCY CONTACTS

AUTHORIZED PICK-UP PERSONS

HELP US OUT

ACKNOWLEDGMENT & ASSUMPTION OF RISK

GIFT OF RIGHT OF PUBLICITY