Swim with the Manatee Aqua Adventure

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You may visit our website and see our other programs and opportunities at https://superkidscience.com/

Email *

First name of participant *

Last name of participant *

Age *

Parent or emergency person's name *

Best Contact Phone Number *

Phone number(s) where I want to receive text messages. We send texts to communicate about our locations, changes and other program information. *

Other emergency contact information

Home address *

Medical needs and allergies we should know about.

What else do we need to know about the participant to help them have the best possible experience?

Photo Permission. Super Kid Science publishes photos in our digital albums to share our adventures, on our website and in our promotional literature and digital posts. No names are ever used in our publications. *

I give consent for participant photos to be published as described above.

Please do not publish photos of this participant

Super Kid Science takes safety and well being seriously. Marilyn Jesrani is certified in first aid, CPR and as an ACA kayak instructor guide. Unfortunately, accidents and mishaps are always possible (and very likely with outdoor activities, especially minor incidents like splinters, scratches, etc..). In order to participate in our programs, you must agree that Super Kid Science, people working our programs and the owners of the locations where our programs are held can not be held liable for injury or loss of property. Any medical expenses that may occur must be paid by your family and through your personal medical insurance. *

I agree

Super Kid Science is not responsible for lost, stolen or damaged property including cell phones and electronics. Always wear clothes and shoes that can get dirty to our programs. *

I agree

I give Marilyn Jesrani of Super Kid Science consent to seek medical treatment for my child or this participant in an emergency. *

I agree

Do you give the participant permission to participate in water activities such as boating and swimming, and if yes, what is their swimming ability? *

Yes, but can not swim.

Yes, beginner swimmer

Yes, can float, hold breath under water and swim to side of pool.

Yes, can float, hold breath under water and swim at least 2 laps in a pool

Yes, Advance swimmer

For the purpose of life vests.... *

Participant is under 50 pounds

Participant is between 50 to 90 pounds

Participant is over 90 pounds

Not applicable

I understand that the manatee snorkeling is based on weather and park conditions. There is always a chance that an act of weather or government/environmental issues may cause a change in our itinerary. We do not expect this to occur, but want our clients to know this is always a possibility. If this does occur, we will substitute another equitable activity in the area. *

I understand

You will receive an invoice shortly which needs to be paid within 3 days to secure your reservation. You may choose to pay in full or pay a $300 nonrefundable deposit. This is a small group trip and we are limiting the number of participants to 8. *

I will pay the $300 nonrefundable deposit with the balance of $630 due by March 5th, 2020.

I will pay in full. I understand that $300 of this payment is nonrefundable,

Required

I allow my child to drive in a car with Marilyn Jesrani or another Super Kid Science leader that is entrusted by her. Please check all that apply. *

Yes

My child must be in a car seat and I will bring the car seat to the program.

I give permission for my child to sit in the front seat

Required

This can be wrapped and mailed as a gift for an additional $10. If this is a gift that is being wrapped and mailed, please write 1. the celebratory event (birthday, christmas, hannukah, valentines day, first day of school, etc..) 2. address you would like it sent to 3. message for card. And any other details such as do not mail until.....

Type your full name to acknowledge that you have read and agree to all the information you entered in this form. *

A copy of your responses will be emailed to the address you provided.

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