1. No category

CROW’S WILDLIFE WARRIOR HOLIDAY CLUB APPLICATION &
INDEMNITY FORM
PARTICULARS OF CHILD
Full Name of Child:
Date of Birth:
Gender:
Language/s Spoken:
Dates of Booking:
PERSONAL INFORMATION
Does your child have any medical conditions or allergies, if yes, please specify:
Does your child have any special dietary requirements, if yes, please specify:
CONTACT INFORMATION FOR BOOKING
Main Contact for Booking:
Relationship to Child:
Phone No:
Please tell us where you heard about our Holiday Club?
INDEMNITY
I,
Identity Number________________________________
The Parent/Guardian of ______________________________
confirm that I fully indemnify CROW for any injury, loss, damage of property, medical expenses, pain and
suffering, temporary or permanent disablement or any other condition that results from the above named child
attending CROW’s Wildlife Warrior Holiday Club programme.
Signed:
Date:
_
PARENT/GUARDIAN CONTACT INFORMATION (1)
Person to contact in case of emergency:
Relationship to child:
Phone No:
Address:
Additional Phone No:
Email:
Name of Family Doctor:
Contact Number:
PARENT/GUARDIAN CONTACT INFORMATION (2)
Person to contact in case of emergency:
Relationship to child:
Phone No:
Address:
Additional Phone No:
Email:
Name of Family Doctor:
Contact Number:
PLEASE NOTE:
AS A PROFESSIONAL WILDLIFE REHABILITATION CENTRE, CROW IS COMMITTED TO RELEASING ALL OF ITS WILDLIFE PATIENTS
BACK INTO THE WILD. AS A RESULT, HUMAN CONTACT WITH OUR ANIMALS IS KEPT TO A MINIMUM AT ALL TIMES TO PREVENT
THEM BECOMING TAME DURING THE REHABILITATION PROCESS. NO CHILDREN WILL THEREFORE BE PERMITTED TO TOUCH AND
OR PLAY WITH ANY OF OUR ANIMALS AS PART OF THEIR H OLIDAY CLUB EXPERIENCE.
1
PAYMENT INSTRUCTIONS
Payments for CROW’s Holiday Club can be made via EFT using the following bank account details:
Acc Name:
Bank:
Acc No:
Branch Code:
CROW
FNB
507 702 308 59
221426
Reference:
Please be sure to give your name as the reference for the payment.
NB: Bookings are only confirmed upon receipt of payment and the completed Application & Indemnity Form.
No payments will be accepted on the day.
All proceeds raised from CROW’s Holiday Clubs go directly towards CRO W’s work in rescuing, rehabilitating
and releasing injured and orphaned wildlife.
THANK YOU FOR YOUR SUPPORT
2