Australian Reptile Park Kids 2 Keepers programme

"Kids 2 Keepers" Registration and Order Form

Please note that your order takes 48hrs to process

Participant Details:
Participant Name:
Date of birth:
Address:
Email:
Contact Number Home:
Mobile:
Emergency Contact Name:
Relationship to Participant:
Emergency day contact number:
	Do you have any medical conditions that may affect your participation in the K2K programme: YES NO
	If Yes please provide details:
	Do you have any allergies: Yes No
	If Yes please provide details:
	Do you have any special food requirements: Yes No
	If Yes please provide details:
Declaration Please read, print and sign declaration Note* Declaration must be brought with you the day of your K2K programme Download Declaration I have read, printed and signed the Declaraion
Payment Details:
Type of Payment:	Credit Card Cheque Money Order
Type of Card:
Name on card:
Card Number:
Card Expiration:	mm/yy
Payment Amount:	$
	Please ensure all details are correct. Cheques and money order payable to: Australian Reptile Park. PO BOX 737 Gosford NSW 2250 *Note: please attach participants name to payment