Registration Form
Child's Information
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Child's Last Name First Name
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Age Date of Birth Sex
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Address City State Zip Code
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Parents' or Guardian's Name Home Phone Work Phone
Registration Information Member # ____________
Session # Class Name Fee
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| | | | _____ Family/Grandparents
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| | | | _____ Donor
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| | | | _____ Patron
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| | | | _____ Sustaining
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Payment Total: | |
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Make checks payable to Happy Hollow OR check one: ___Visa ___ Mastercard ___ Discover
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Customer Signature Credit Card Number Expiration Date
Refund Policy: Refunds must be requested two weekes prior to the date of the first class meeting.
Because of administrative costs, a $10 fee is retained for each cancellation. Sorry, refunds for
cancellations made less than 14 days prior to the start of your child's class cannot be granted.
Classes with insufficent enrollment may be cancelled. In such cases, you will be notified prior
to classes and a full refund will be issued.
Emergency Information
Please list the person to be called when the parent or guardian cannot be reached
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Name Relationship Daytime Phone
Allergies or other physical problems ____________________________________________
Liability Release
The undersigned, in consideration of participation in the above classes, agrees to indemnify and hold the City, South
Bay Zoological Society, Happy Hollow Corporation and Happy Hollow Park & Zoo harmless, and release the City, SBZS, HHC,
and HHP&Z; of any and all liability for any injury which may be suffered by the above named individuals(s) registered in
the classes, arising out of or in any way connected with participation in the classes except as arises out of sole
willful act of sole active negligence of the City, its' officers, agents or employees. I have read the above agreement,
and fully understand that I assume all risk for injury received. I also authorize HHP&Z; to use my child's name and
photograph for education and public relations purposes related to the zoo. In case of emergency, when parent or
guardian cannot be reached, I hereby give my permission to Happy Hollow Park & Zoo to secure treatment for my child.
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Signature Date
Mail To:
Education Department
Happy Hollow Park & Zoo
1300 Senter Road
San Jose, CA 95112
or Fax to: 408-298-1289
Classroomwild@aol.com