Field Trip Friends Inc. » Registration Form

Child's Name*

FirstLast

Child's Age*

Child's Birthday*

MM

DD

YYYY

Allergies/Special Needs

Add Siblings

Would you like to add a sibling?

Sibling 1's Name*

FirstLast

Sibling 1's Age*

Sibling 1's Birthday*

MM

DD

YYYY

Sibling 1's Allergies/Special Needs

Would you like to add a 2nd sibling?

Sibling 2's Name*

FirstLast

Sibling 2's Age*

Sibling 2's Birthday*

MM

DD

YYYY

Sibling 2's Allergies/Special Needs

Would you like to add a 3rd sibling?

Sibling 3's Name*

FirstLast

Sibling 3's Age*

Sibling 3's Birthday*

MM

DD

YYYY

Sibling 3's Allergies/Special Needs

Mom's Info

Mom's Name*

FirstLast

Mom's Email*

Mom's Cell Phone*

(xxx)xxx-xxxx

Mom's Home Phone

(xxx)xxx-xxxx

Mom's Address*

Street AddressCityStateZip Code

Dad's Info

Dad's Name*

FirstLast

Dad's Email*

Dad's Cell Phone*

(xxx)xxx-xxxx

Dad's Home Phone

Dad's Address (if different)

Street AddressCityStateZip Code

Is it alright to text you?*

Emergency Contact

Emergency Contact's Name*

FirstLast

Emergency Contact's Home Phone*

Emergency Contact's Cell Phone*

Relationship to Child*

Doctor's Information

Child's Doctor's Name*

FirstLast

Doctor's Phone*

Medical Insurance Policy Type and Number*

Class Info

How did you hear about us?

Do you have memberships anywhere (Zoo, Bishop Museum, etc)?

Social Media*

FaceBook?
Twitter?

Do you? (Please choose all that apply.)

List any friends you would like to be in class with.

Select Season*

Select Class Day*

Please choose only from classes offered for this session on "Classes" page.

Select Weeks*

Please choose only from classes offered for this session on "Classes" page.

Verify your payment due.*

Comments and/or Living Social Voucher # (if applicable)

Waiver Agreement

I, as the parent, Agency Representative or Legal Guardian of the child/children stated above, will be solely responsible for the child/children at all times during Field Trip Friends, Inc. (FTF) programs & hereby hold FTF harmless & not responsible for any & all damages, injuries, or loses that may be sustained while in the care of FTF. I have read FTFs Policies & Procedures, Registration, & Tuition information at www.fieldtripfriends.com & accept the terms stated within. Due to the unique design & independent creation of Field Trip Friends, Inc. (FTF), I , the undersigned, understand that submission of this registration creates a confidential relationship between me, the undersigned, & FTF. I further understand & agree that I am obligated to remain loyal to FTF by not disclosing its trade secrets, original ideas, & private locations to a potential competitor or use them to establish or create my own similar program. I understand that this type of intellectual piracy by implication or otherwise will be a breach of the confidential relationship between me & FTF. I give permission to Field Trip Friends, Inc. (FTF) & its professional photographers to photograph &/or videotape the adults & children named above & allow use of the resulting photos/videos for sale on photographers private websites, & for FTF, Inc's education, evaluation, marketing, documentation, &/or sharing amongst members. I understand that all photo websites will be password protected for FTF members only, & all professional photographers will contact parents directly for written permission to use the photos for other professional &/or commercial reasons (portfolios, advertising, etc.)

Name of main adult attending field trips & relationship.*

By typing your name and relationship to child into this box, you legally agree to the Waiver Agreement Above.*

Name of additional adult attending field trip & relationship.

By typing your name and relationship to child into this box, you legally agree to the Waiver Agreement Above.*