Welcome to Safari Camp 2015 at Chimp Haven!

Welcome to Safari Camp 2015 at Chimp Haven!

Come join us to learn about the wonderful world of Apes. Children will learn about a new ape species every day including where each ape lives and their favorite things. Children will explore the ape world through crafts, games, and activities. A snack and water will be provided each day. At the end of the week, families* are invited to join us at camp to see what their children have learned throughout the week and tour the grounds. Transportation from Shreveport is included** unless parent prefers to drop their child off directly at Chimp Haven.

Who: Children ages 8-12

What: Apes Safari Camp

When: June 22-25, 2015 from 8:00am-12:00pm, June 26, 2015 from 8:00am-1:00 pm

Where: Chimp Haven

13600 Chimpanzee Place

Keithville, LA 71047

Price: $165 for all registrations received by April 17, 2015 at 5:00 pm CDT

$175 for all registrations received fromApril 18, 2015-June 20, 2015(no registrations accepted after June 20, 2015)

*Lunch for one parent/guardian and the camper is included in the cost of camp. One additional guest may join the child for lunch/tour for $10. Due to size limitations, each child may only invite two family members maximum. Parents may join us at Chimp Haven at 11:45 am on Friday, June 26, 2015.

**Transportation provided from Shreveport to Chimp Haven and back at:

Brookshires Parking Lot (near gas pumps). Look for the school bus.

9250 Mansfield Road

Shreveport, LA 71118

Drop off at Brookshires between 7:00 am-7:30am. The bus will leave Brookshire’s parking lot at 7:30 am sharp to arrive at Chimp Haven promptly.

Pick up at BrookshiresMonday-Thursday between 12:30pm-1:00pm. All children must be picked up by 1:00 pm.

Pick up at Brookshires on Friday (due to end of camp program) between 1:30pm-2:00pm. All children must be picked up by 2:00 pm.

We must receive a minimum of 10 participants to hold a camp session this summer. If Chimp Haven chooses to cancel camp, full refunds will be given. No refund will be given if the individual cancels their camp attendance for any reason.

Safari Camp Registration Form 2015

Name of Child:______Birth date:______

Name of Parent/Guardian______Registration Date:______

Address:______

______

Email Address:______

Phone Number: Cell______Home/Work______

Emergency Contact (other than parent): ______

Emergency Contact Phone Number: ______

Allergies: ______

Dietary Restrictions (including parent attending Friday’s lunch):______

______

List anyone authorized to pick your child up from camp if you cannot (alternate must provide ID):

______

______

Payment: Credit Card Check (enclosed)

Credit Card Number:______Expiration Date:______

Registration received by April 17, 2015 at 5:00 pm CDT - $165

Registration received from April 18, 2015-June 20, 2015 - $175

Additional Lunch on June 26, 2015(one parent and child included in registration) - $10

Total (registration price + lunch (if applicable): $

Sanctuary Property Admission Agreement – Minor Age Visitors

We, the undersigned, hereby acknowledge that admission onto the sanctuary property owned and operated by Chimp Haven, Inc. necessarily involves certain risks, which risks, though remote, include the risk that I could sustain injury, harm or loss while visiting the said property due to circumstances beyond the control of Chimp Haven, Inc., its officers, directors, and members. With full knowledge and assumption of these risks, I have voluntarily chosen admission to the sanctuary property located in Keithville, Louisiana.

I further acknowledge that Chimp Haven, Inc., its officers, directors, nor members warrant the safety of the visitors to the sanctuary property. As a condition for admission to the sanctuary property, I do hereby relieve, hold harmless, and agree to indemnify Chimp Haven, Inc., its officers, directors and members from any liability for any injury, harm, or loss that I may sustain while visiting the sanctuary property.

I agree that I will only take photos or videos if given permission by a designated representative of Chimp Haven, Inc. These images will only be for my personal use unless I have entered into a signed agreement with Chimp Haven, Inc. I also authorize Chimp Haven to use my child’s photograph for publication and/or advertisements promoting the Classrooms that Care program. I understand that the use of the photographs will be without compensation to the child or the child’s parent or guardian.

CONFIDENTIALITY: In connection with the visitation and interaction between Visitor/Contractor and Chimp Haven, Inc, it is anticipated that Visitor/Contractor may have access to certain business information, financial information, research, technology, data, records, animals, trade secrets, and commercial information. As a condition to the said access to the facility, the Visitor/Contractor agrees to treat said resulting information as confidential, privileged, and protected from disclosure to unauthorized persons. Visitor/Contractor further agrees that such information will not be disclosed to any other party or entity, except with the specific prior written consent of Chimp Haven, Inc.

IN WITNESS, WHEREOF, this agreement is executed on this ______day of ______, 20 ____.

VISITOR (Minor Age):

Print Name:

Signature:

PARENT/LEGAL GUARDIAN:

Print Name:

Signature:

Sanctuary Property Admission Agreement and

Waiver and Release of Liability for Activities at Chimp Haven, Inc.

(For Visiting Parents)

We, the undersigned, hereby acknowledge that admission onto the sanctuary property owned and operated by Chimp Haven, Inc. necessarily involves certain risks, including, but not limited to, the potential that I could sustain physical injury, property injury, or other harm or death, which may be caused by any animal or the negligent acts of any individual. With full knowledge and assumption of these risks, I have voluntarily chosen admission to the sanctuary property located in Keithville, Louisiana.

I agree to assume all risks, liabilities and responsibility for any physical injury, property injury, or other harm or death that may occur while I am on the Sanctuary grounds.

I do hereby relieve, hold harmless, and agree to indemnify Chimp Haven, Inc., its officers, directors, agents, assigns, employees, volunteers or interns from any liability for any injury, harm, or death that may occur while I am on the sanctuary grounds.

I intend by this Waiver and Release to release Chimp Haven, Inc. and its officers and directors, agents, assigns, employees, volunteers and interns from any liability or responsibility for physical injury, property injury, or other harm or death that may occur while I am on the Sanctuary grounds. I intend this Waiver and Release and its terms to apply whether any injury liability arises from the negligence or carelessness on the part of the persons or entities being released from dangerous or defective property, or equipment owned, maintained or controlled by them or because of their possible liability without fault. I understand and agree that this Waiver and Release is binding.

I understand that I am waiving, permanently and in advance, my rights to seek any recovery or compensation for physical injury, property injury, or other harm or death that may occur while I am on the Sanctuary property. I understand that this Waiver and Release is without exception and is binding upon me and my heirs.

I have carefully read this Waiver and Release and fully understand its contents. If I am under 18 years of age, my parent or legal guardian has completely reviewed this Waiver and Release, understands and consents to its terms, and authorizes my participation by his or her signature below. I am aware that this is a RELEASE OF LIABILITY and I sign of my own free will.

I agree that I will only take photos or videos if given permission by a designated representative of Chimp Haven, Inc. These images will only be for my personal use unless I have entered into a signed agreement with Chimp Haven, Inc. I also authorize Chimp Haven to use my photograph for publication and/or advertisements. I understand that the use of the photographs will be without compensation.

Print Name:

Signature:Date: ______

13600 Chimpanzee Place, Keithville, LA 71047

Phone: (318) 925-9575 Fax: (318) 925-9576 Email: