Educational Zoo Document

Educational Zoo Program Consent and Release Agreement

Program and Visit Details

Program / Event Name:

Zoo / Location:    Scheduled Visit Date:

Departure Time:    Return Time:

Transportation provided by: School bus Public transit Parent/guardian transport Other

Student Information

Date of Birth:    Student ID:    Grade / Program:

Parent / Guardian Contact

Relationship to Student:

Emergency and Medical Information

Emergency Contact Name:    Phone:

Relationship to Student:

I authorize program staff to administer the student’s prescribed medication while on the visit: Yes No

Permissions, Acknowledgments and Releases

By signing below, I represent that I am either the student (if age 18 or older) or the parent/legal guardian with authority to consent for the student. I authorize the student to participate in the Educational Zoo Program described above. I acknowledge and agree to each statement below as indicated:

I understand that participation involves inherent risks including contact with animals, uneven terrain, and group transportation. I accept those risks on behalf of the student.

I will ensure the student follows all program rules, staff directions, and zoo policies. I understand failure to comply may result in removal from the activity at my expense.

I grant permission for the student to travel via the transportation method(s) indicated above.

I authorize the zoo and program staff to photograph or record the student for educational and promotional purposes, without compensation. I understand images may be used in printed materials and institutional publications.

Medical Authorization: If I cannot be reached in an emergency, I authorize qualified medical personnel to provide emergency medical treatment for the student and to transport the student to an appropriate medical facility. I understand that program staff will make reasonable efforts to contact me prior to and during any emergency care.

Release and Indemnity: To the maximum extent permitted by law, I release and agree to indemnify and hold harmless the school, program leaders, the zoo, its employees, volunteers, and agents from any and all liability, claims, demands, actions, and causes of action arising out of or related to injury, loss, or damage sustained by the student in connection with participation, except to the extent caused by gross negligence or willful misconduct.

Transportation Acknowledgment: If private vehicles or volunteer drivers are used, I acknowledge that such drivers are not agents of the school and that I have provided accurate information about vehicle insurance and driver qualifications if requested by the school.

Fees and Payment

Program Fee (if applicable): $    Payment Arrangement:

I accept financial responsibility for the program fee and any costs associated with medical care or early dismissal due to disciplinary actions.

Acknowledgment of Policies

I acknowledge that I have read and understand the applicable safety procedures and field-trip policies provided by the school or program and agree to comply with them. I understand that any exceptions or special accommodations must be documented in writing prior to the trip.

Certifications and Signature

Certification: By signing below I certify under penalty of perjury that I am the parent or legal guardian of the student named in this form, or the student if age 18 or older, and that the information provided herein is true and complete to the best of my knowledge. I have read and understood this Consent and Release Agreement and agree to be bound by its terms.

Relationship to Student (select applicable): Parent Legal Guardian Student (18+)

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