JUNIOR WILDLIFE EXPERIENCE - APPLICATION FORM
APPLICANT'S DETAILS (Person taking part in the Junior Wildlife Experience:
Title:  First name:  Surname:
Ages 6 - 15 Date of birth: Age at date of event (Date no 1 below):
  Name of adult accompanying applicant:
Home address:
Home address:   Post Code:
BOOKING DETAILS
Please give two alternative dates that you would like to take part - from April to October, (excluding Bank Holidays).
Date no 1: Date no 2:
Date of last tetanus injection:
Details of any allergies:
Details of any medical conditions:
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
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
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:
Junior Wildlife Experience, 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