"*" indicates required fields Step 1 of 4 25% *This form is for online (PayPal) purchases only. To arrange payment through other methods, please complete and submit form, then contact us at education@austinzoo.org. Parent/Guardian Name:* First Last Child's Name:* First Last Child's Age (at the time of camp)*Address:* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email:* Phone Number:*Alternate Phone Number:Are you an Austin Zoo member? Yes No I'm not sure Please contact the Austin Zoo so we can determine the status of your membership before you complete this form. Phone: (512) 288-1490 Member Price:Dates: Saturday, February 11, 2023: Animal Families Saturday, February 25, 2023: Animal Mythbusters Saturday, March 11, 2023: Junior Naturalists Saturday, March 25, 2023: Animal Professionals Saturday, April 8. 2023: Wonderous Wanderers Saturday, April 22, 2023: Island Adventures HiddenSeries 2: Saturday, November 14, 2020: Australia Nonmember PriceDates: Saturday, February 11, 2023: Animal Families Saturday, February 25, 2023: Anilmal Mythbusters Saturday, March 11, 2023: Junior Naturalists Saturday, March 25, 2023: Animal Professionals Saturday, April 8, 2023: Wonderour Wanderers Saturday, April 22, 2023: Island Adventures HiddenSeries 2: Saturday, November 14, 2020: Australia Total Please describe any allergies, their reactions and treatment. Is there anything else we should know about your child to help us ensure his/her best chance at success? This health history is correct as far as I know, and the child described has permission to engage in all program activities except as noted by me.* I agreeEmergency Contact Name:* First Last Emergency Contact Number:*Emergency Contact Relationship:* Emergency Contact Name #2: First Last Emergency Contact Number #2:Emergency Contact Relationship #2: AUSTIN ZOO - AUSTIN ZOOLOGICAL SOCIETY RELEASE FORM* I AgreeIn consideration of my child being allowed to participate in Austin Zoo camp programs. I, the undersigned parent/legal guardian, do hereby release and agree not to hold liable Austin Zoo, its officers, agents and employees, from any and all actions, causes of action, claims, demands, costs or damages as a result of property damages or personal injuries or death sustained by my child on Austin Zoo’s property arising from or resulting from an act or omission, negligent or otherwise, of Austin Zoo, its officers, agents or employees while participating in Austin Zoo programs. Child Consent* I AgreeConsent is hereby given for my child to attend Austin Zoo programs and permission is given for any emergency medical treatment which might be necessary. In case of medical emergency, and in the event that I cannot be reached or present, I give permission to the Austin Zoo staff to secure medical treatment, including hospitalization, for my child. I understand that some camp activities such as husbandry and hiking carry inherent hazards and are physically strenuous. PHOTO/VIDEO RELEASE* I AgreeI hereby authorize Austin Zoo and Austin Zoological Society to use, reproduce and/or publish photographs and/or video that may pertain to me or my child/ren– including images, likenesses, and/or voices without compensation. I understand that this material may be used in various publications, public affairs releases, recruitment materials, broadcast public service advertising (PSAs), multimedia exhibits or for other related endeavors. This material may also appear on Austin Zoo and/or Austin Zoological Society’s Internet Web Page and/or digital social media services. I AGREE, and hereby certify that I am the legal guardian of the minor(s) stated and can legally grant permission for the use of his or her image. Total