What program are you attending?
First Child's Name*
Second Child's Name
Please select the date of your program.*
Critter Camp-In T-shirt: Are you interested in purchasing a glow-in-the-dark Critter Camp-In t-shirt (“I Survived the Night at Buttonwood Park Zoo”) for $12? If so, please select the size(s) below and bring the appropriate amount of money in either cash or check (made out to the Buttonwood Park Zoological Society) to the night of your event.*
General Release: In consideration for the services rendered to my above named child, I specifically release and hold harmless the Buttonwood Park Zoo, the Buttonwood Park Zoological Society, and the City of New Bedford, their agents, servants, volunteers, and employees from any and all liability, claims, damages, and causes of action I may now or hereafter have as parent of said minor(s). Further, I hereby give permission for my child to engage in any and all programs and activities of Buttonwood Park Zoo.*
Emergency Authorization: In the event that I cannot be reached, I authorize the Overnight Program Coordinator and medical staff at St. Luke's Hospital to make decisions regarding the emergency care or treatment of my child.*
Media Release: I hereby give permission for pictures and video to be taken of my child to be used for publication purposes. Children will not be identified in photos and video footage.
Participants(s) Medical Information
Is the participant currently taking prescription medication that will need to be taken during the event? If yes, please list:
Please list all allergies for participant(s).
Please list any health or personal concerns that the Overnight Program Coordinator should be aware of in regards to the participant (please include any fears or phobias that may require special attention):
Emergency Contact Information
Please provide an additional emergency contact. If you will be participating in the event, please designate an emergency contact other than yourself.
Refund & Registration Polices: No refund will be given unless a program is cancelled by the Zoo. The Zoo reserves the right to cancel any class which does not meet the minimum enrollment criteria. Thank you for your cooperation. For further information, please call (508) 991-6178 x 67419. Inclement weather cancellations will be available at www.bpzoo.org.