Name of parent(s): Address: City State Zip. Phone: Home Work (Mom) Work (Dad) Mom s Cell: Dad s cell:

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1 Safari Day Camp 2016 Lion Country Safari (561) x Lion Country Safari Road Fax (561) Loxahatchee, FL *** EARLY REGISTRATION*** education@lioncountrysafari.com ***February 15 March 31, No other discounts apply. *** Directions: Please Print or type all answers. Your child will be enrolled after the completed application (including medical information) and payment are received and if space is available. You will receive a confirmation once the completed application is accepted. All parts of the application must be completed in full and signed. Payment must be made in full for all sessions enrolled at time of registration (see page 5). Name of parent(s): Address: City State Zip Phone: Home Work (Mom) Work (Dad) Mom s Cell: Dad s cell: If parents are unavailable in an emergency, please contact (Name) (Relationship to camper): (Phone): Name of Camper 1: (Camper s Last Name) (Camper s First Name) (M.I.) Birthdate: / / Age: Grade ( ): Male Female T-shirt size: Sm. 6-8 Med Lg Ad. Med. Ad. Lg. Ad. X-Lg. Allergies or other concerns? Name of Camper 2: (Camper s Last Name) (Camper s First Name) (M.I.) Birthdate: / / Age: Grade ( ): Male Female T-shirt size: Sm. 6-8 Med Lg Ad. Med. Ad. Lg. Ad. X-Lg. Allergies or other concerns? T-shirts: One T-shirt is included with paid registration, no matter how many weeks child is enrolled. Safari Day Camp T-shirt must be worn each day. Please Note: We use the applications to place our T-shirt order. The size you order is the size your child will receive on the first day of camp. For health concerns, we cannot exchange T-shirts once the child puts the shirt on. We only have VERY LIMITED extra shirts for purchase during camp. Additional T-shirts are available for $10 each with this application. Additional supplies may not be available once camp begins, so if you wish to purchase additional shirts, purchase them now. # extra T s for Camper 1 # extra T s for Camper 2 TOTAL # OF ADDITIONAL T-SHIRTS AT $10 PER SHIRT = $ (See p. 5) page 1

2 Weekly Sessions Safari Day Camp 2016 Please check the week(s) for which you are applying. The themes for each week are noted; however, they are subject to change without notice. There are 3 lion enrichment weeks. Wk# Dates Mammal Bird Reptile Zoo Nature/ Habitats 1 June Zebra Budgie Lizards Tools of the Trade The Americas 2 June Donkey Lory Snakes Chimp Amphibians 3 June 27 July 1 Llama African grey Tortoises Animal Artist Rocks & Minerals 4 July 4*-8 Rhino Crane Alligator Reptile Rainforest 5 July Antelope Amazon Skinks Vet Fish 6 July Monkey Ostrich Pythons Animal Theatre Digging Dinos 7 July Radical Flamingo Turtles Petting Zoo Africa Rodents 8 Aug. 1-5 Giraffe Pelican Iguanas Bird Bugs 9 Aug Lion Macaw Dragons Animal Chef Backyard Habitat Please note that registration is available on a first-enrolled, first-served basis. Camp sessions fill up quickly, so please register early. *Safari Day Camp is in session each week, Monday Friday, including any holidays Total number of weeks applying for: Request to be placed with a friend or relative: You may choose 1 friend or relative (who is within 1 year of camper s age) to be placed with your child. Although we cannot guarantee that the campers will be placed in the same group, we will make every effort to accommodate your request, as long as both parties request being placed together and campers are same age. Due to our small group sizes, we cannot accept requests for more than 1 friend or relative per camper. Name of friend/relative: Age: page 2

3 EARLY REGISTRATION RATE SCHEDULE 2016 Parents: Sometimes paperwork is misplaced, faxes go astray, and mail is not delivered. Unless you have a receipt and confirmation from our camp, your child is NOT registered. If you have not received a receipt and confirmation within 3 days of sending in your application materials, check your spam folder. If you still have not received these, please contact us. We do our best to accommodate reasonable requests. However, there are some things we cannot do. When we are at capacity, we cannot add spaces. Please note that we reach capacity most weeks. We will try to accommodate special requests for placement, but we will not honor requests that are detrimental to the interests of camp. For example, we will not place a very young child with a much older sibling in a group of older campers. Likewise, we will not place a much older camper with a group of young campers. Thank you for your understanding. Early Registration Rate 2016 EARLY REGISTRATION RATE ENDS MARCH 31, 2016 (OR EARLIER IF CAMP IS FULL)! No other discounts apply Number 1 camper 2 campers of Weeks Enrolled 1 $185 $370 2 $370 $740 3 $555 $1,110 4 $740 $1,480 5 $925 $1,850 Number 1 camper 2 campers of Weeks Enrolled (cont d) 6 $1,110 $2,220 7 $1,295 $2,590 8 $1,480 $2,960 9 $1,665 $3,330 Camp Sessions run from 9:30 am to 4:30 pm Monday - Friday. Extended care is available for $10 extra per day, per camper, from 8:00-9:30 a.m. and/or 4:30-5:30 p.m. Registration for extended care must be made in advance. If you drop your child off before 9:15 am or pick up after 4:30 pm, you will be charged the $10.00 for extended care. The park closes at 5:30 pm, so extended care ends at 5:30. You must make arrangements to pick up your child by then. Extended care required? No Yes Which Day(s)? Monday Tuesday Wednesday Thursday Friday Total # of days extended $10 per day per camper = $ total ext. care (see p. 5) Please note: Early registration ends March 31, Beginning April 1, 2016, price will be $250 per week, per camper.

4 page 3 Safari Day Camp Behavior Expectations We anticipate that your child/children will have a great time at Safari Day Camp. But, in order for all involved to gain the most from the experience, there are certain rules that all must follow. PLEASE READ THESE RULES TOGETHER (PARENT AND CHILD). Keep a copy for your records. At all times: Respect your fellow campers and counselors. Keep your hands and feet to yourself. Walk on sidewalks. Be respectful of other guests at Lion Country Safari, too. WALK at all times and treat others the way you would like to be treated. Remain quiet and listen when your counselors, directors, or staff members are talking. Stay with the group to which you are assigned. NEVER touch any animal unless you have been given permission to do so at that time. Keep your hands and any objects you are carrying out of animal enclosures. In the van: Buckle your seat belt and stay seated at all times. Keep your hands and all objects inside the vehicle. Talk in a quiet voice. At the pool area: No diving. Always listen to the lifeguard, counselors, and directors. This list of rules and expectations is intended as a guideline. Other rules not listed here may also be enforced. They are in place for the safety of the children, for the safety of the animals, for the safety of our other guests, and so that everyone may experience an enjoyable time with us. Rule violations will be handled in the following manner: First incident: Verbal warning and explanation of the expected behavior. Second incident: Time-out and written discipline report will be given to the parent(s) and camp director. Third incident: Camper will be removed from the group. A written discipline report will be given and the camp director will be contacted for a conference with the camper. At this time, parent(s) will be contacted by telephone to pick up the camper. Please note: All incidents are subject to camp counselor and management judgment and may require more severe consequences, such as parent conferences or dismissal from camp. Campers may be dismissed from camp for unsafe or disruptive behavior with no refunds. Signing at the end of this Safari Day Camp application (page 5) indicates that we have read, understood, and agree to abide by these rules.

5 page 4 Payment Page Safari Day Camp Early Registration 2016 Weekly tuition includes: Lunches, snacks, T-shirt, cap, water bottle, craft supplies, and admission to all activities. Only one T-shirt, water bottle, and cap will be given to each camper, regardless of number of weeks enrolled. Additional supplies (T-shirts, caps, water bottles) may be purchased for $10 each with registration or from the director during camp (if available supplies limited). Cost of tuition (see appropriate chart, page 3) $ extended care ($10 per day, each child) + $ extra T-shirts ($10 each) + $ Grand Total (PAYMENT DUE NOW) = $ **Early registration prices in effect February 15 March 31, No other discounts apply. ** Payment MUST BE MADE IN FULL with registration. Note: Your child will be enrolled in summer camp only for the week(s) paid in full. You will receive an confirmation once your camper is enrolled. A non-refundable fee of $50.00 per child will be held if your child is withdrawn from camp up to two weeks prior to date of enrollment. After that, no refunds will be issued. Method of payment Check Visa MasterCard American Express Discover Credit card # Exp. date Note: Credit card number will NOT be kept on file. I authorize the use of still photographs, video, and sound recordings of my child for promotional and advertising purposes relating to Safari Day Camp and/or Lion Country Safari, Inc. FL (Lion Country). I authorize emergency medical treatment for my child, including transport to the nearest hospital. I assume all risks and hazards incidental to my child s participation in the activities of the Camp Program and unconditionally indemnify, save and hold harmless, Lion Country Safari, Inc. FL, its directors and employees from all claims, suits, actions, and damages relating to personal injury, loss of life, and/or damages to personal property which may be sustained by my child while on or in the vicinity of the premises of Lion Country. I affirm that all information provided on this application is true to the best of my knowledge, including the age of the camper. I agree to provide proof of my child s age (birth certificate or passport) if asked by the camp director. I understand that misrepresentation may result in my child s dismissal from camp. Lion Country reserves the right to require the withdrawal of any camper if, in the opinion of the camp director, such withdrawal is in the best interests of the camp (see Safari Day Camp Behavior Expectations, p. 4). I have read and agree to all enrollment conditions. By signing below, I also authorize payment to be made to my credit card listed above (if applicable). Parent Signature: Date: Parent signature required. Applications will not be accepted without signature and date. Office Use Only: Rec d Staff: Amt Meth Sessions