NATIONAL ZOOLOGICAL GARDENS

OF SOUTH AFRICA

ZooAdventure: ANIMAL SENSES

2017 School Holidays

______

Please complete one form per child

Name and surname of child: ______

Age: _____ Grade: ______Gender: ______School: ______Cell: ______

Any medical condition such as allergies that the National Zoo needs to be aware of: ______

Title, name and surname of parent/ guardian: ______

Cell: ______Email: ______

Postal address: ______Code: ______

Where did you hear about the course: ______

Course detail:

Please mark the date of your choice

Title : ZooAdventure: ANIMAL SENSES

24 September 2017
03 October 2017
05 October 2017
13 December 2017
19 December 2017

Language : English

Grades : 4-6

Times : 8h00 – 16h00

Fee : R 100.00 per child

Banking details:

Bank: ABSA

Account holder: National Zoo

Account number: 406 014 5151

Branch code: 323 345 (Pretoria)

Reference: ZA-AS & surname of child

Meals and / or refreshments are not included in the course fee. Food and drinks should either be brought along or could be purchased at our restaurant facilities.

Indemnity:

I, ______(name and surname), parent /guardian

of the child named above hereby agree to the conditions of course registration as indicated below:

Signature: ______Date______

In view of the fact that my child is prepared to attend a course at the National Zoological Gardens of South Africa

(hereafter referred to as the “Zoo”), and in view of the fact that the Zoo is prepared to accommodate him/her on the above-mentioned course, I therefore agree to:

1. Accept all risks and irrevocably indemnify the Zoo against any loss, damage, costs, expenditure or injury, including physical or psychological injury, illness or disfigurement that may arise directly or indirectly out of his/her presence on the course or in any other capacity, in any building or on the premises or in vehicle of the Zoo.

2. I further declare that I am conversant with the nature and extend of the course, duties and activities, as well as the extent of all risks, injuries, loss or damage which may directly or indirectly result from his/her attendance of the aforementioned course or in any other capacity in the Zoo or in any of the Zoo’s buildings, premises or vehicles.

3. I furthermore declare not to instigate any claim of whatever nature or arising out of whatever reason against the Zoo, any of its personnel, officials or agents, whether the claim is directly or indirectly related to or arises from his/her tasks or his/her presence in his/her capacity as a course participant or in any other capacity in the Zoo or any of the Zoo’s buildings, premises or vehicles.

For office use:

Amount: ______Receipt number: ______Date: ______