One On One Wildlife Encounters Application Form

ONE ON ONE WILDLIFE ENCOUNTERS - APPLICATION FORM
APPLICANT DETAILS (Person(s) applying for the Close Encounter):
(1) Title: First name: Surname: (2) Title: First name: Surname:

(1) If under 18 -	Date of birth:	Age at date of event (Date no 1 below):
(2) If under 18 -	Date of birth:	Age at date of event (Date no 1 below):

(1) If under 18 -	Name of parent or guardian:
(2) If under 18 -	Name of parent or guardian:

Contact address:

Contact address: Post Code:

Daytime phone number: Mobile:

Email address:

BOOKING DETAILS

Applicant(s) per Close Encounter: Meerkats Penguins Combo(Meerkats AND Penguins)

Please give two alternative dates that you would like your Close Encounter - from April to October, (excluding Bank Holidays).
Date no 1:	Date no 2:

(1) Date of last tetanus injection:

(2) Date of last tetanus injection:

(1) Details of any allergies:

(2) Details of any allergies:

(1) Details of any medical conditions:

(2) Details of any medical conditions:

(1) Details of any special needs:

Name & telephone number of a person to be contacted in the event of an emergency on the day:

DETAILS OF FEE PAYER (If different from above)

Title: First name: Surname:

Home address:

Home address: Post Code:

Daytime phone number: Mobile:

Email address:

PAYMENTS - to reach us at least 10 days prior to the event

Includes a half hour close encounter (1 hour with combo) - a DVD of photos - plus a lifetime of memories.

1) By card - please phone 01983 612153 to arrange payment by credit or debit card.

2) By cheque - please make payable to: Flamingo Park (Seaview) Ltd. (not forgetting your card's cheque guarantee number on the reverse of your cheque) and post it to:
Close Encounters, Seaview Wildlife Encounter, Oakhill Road, Seaview, Isle of Wight, PO34 5AP

The numbers below are for security only, and have NO connection with your order whatsoever.

Please type the red numbers here