Kestrels Registration Form - Friday 10:00am - 12:00pm (Summer 2023) This form completes your registration for the full session of Summer Kestrels 2023. Child's Name* First Last This form should be filled out by the above named child's parent or guardian.* I am the parent/guardian of the child named above. Child's Gender Pronoun* He She They Child's Birth Date* Month Day Year (Must be between the ages of 7 and 10 at the time of the first class)Contact InformationParent/Guardian Name* First Last Are you a Great Lakes Aquarium member?* Yes No Not sure? Call to ask at (218) 740 - 2031 Parent/Guardian Phone Number*Parent/Guardian Email Address* Home Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Alternate Adult Contact Name* First Last Alternate Adult Contact Phone Number*Alternate Adult Contact Email Address* Alternate Adult Contact's Relationship to Child* Pick Up AuthorizationAt the end of class, I authorize Great Lakes Aquarium to release my child to the following adult(s) or guardian(s) other than myself:Confidential Health FormPlease take the time to fill out this form accurately and completely. This information is essential for your child's safety and enjoyment of Kestrels.Is your child allergic to any of the following?* Penicillin Aspirin Foods (list types below) Insects (list types below) Other (list below) No known allergies Food Allergies* Insect Allergies* Other Allergies* Please describe the allergic reaction(s) and how it is usually treated:Does your child have a history of any of the following?* Raynaud's syndrome Poor circulation Seizures Diabetes Dizziness Migraines Back problems Knee/joint problems Abnormal blood pressure Respiratory problems Asthma (cold- or exercise-induced) Heart disease None of the above For all medical history boxes you checked above, please describe symptoms, usual treatments and current status.*Is your child currently taking any medication? If so, please describe and explain.*Are there any other health concerns/conditions that we should know about?*Kestrels Nature Play - Great Lakes Aquarium Waiver and ReleaseGreat Lakes Aquarium maintains high standards for safety. Please read thoroughly to help us maintain safe and informed programming.Parent/Guardian Acknowledgment* I am the parent or guardian of the participant. I understand, answer, and agree to each of the questions in this application on behalf of the participant.Participant Waiver*Parents, please be aware that nature play has inherent risk associated with it as children run, climb, jump and play in whatever way they choose to interact with nature. This risk is good for children and their development and is carefully monitored by present educators. While we will do what is in our power to minimize this risk, the nature of these activities indicates an increased level of risk is inevitable. Just like it is safer to walk than it is to run! I understand that I (or my child) am participating in the above program at our own risk. I will not hold Great Lakes Aquarium or its officers, directors, employees or volunteers liable for any negligence or alleged negligence or other fault (not including intentional acts) that results in personal injury, death, or property damage during or in connection with the above program. The undersigned, for myself and for my heirs, executors, administrators and assigns, hereby release and forever discharges Great Lakes Aquarium and its officers, directors, employees, and volunteers from all such claims. The waiver will be construed according to the law of the State of Minnesota. I have read and agree to the participant waiver on behalf of my child.Location Waiver*While most of the nature play activities will be taking place at or on Great Lakes Aquarium property, we may, at our discretion, walk the group next door to Bay Front Festival Park for some additional activities. If this is selected we will have minimum of 2 educators/staff members present to monitor and supervise the group. The park is directly adjacent to Aquarium property and does not require us crossing or walking on any roads shared by vehicles. By checking the box below you are giving express permission for this to occur. This program takes place entirely outdoors (with the exception of bathroom and warming breaks) unless prevented by unanticipated dangerous weather conditions. I have read and agree to the location waiver on behalf of my child.Medical Release*I hereby give my permission for Great Lakes Aquarium to procure all necessary medical help for myself, my child or ward while said person is under the direct supervision of Great Lakes Aquarium, and grant permission to its representatives to authorize any competent medical professional to do all things reasonably necessary to take care of any injury or sickness. There is no health insurance or medical coverage provided. Checking the box below acknowledges that the participant/guardian accepts responsibility for payment of any medical treatment which may be required while they are in this program. I have read and agree to the medical release on behalf of my child.Photo Release*I grant permission for Great Lakes Aquarium to use photos and/or video of this child in: (Check all that apply) Print and digital publications and Aquarium promotional materials The Aquarium's social media pages Local news media (newspaper, television, web content, etc.) in the event the program is featured in local news None of the above PaymentCompleting this payment secures your place in the 8-week session of Kestrels.Refund/Cancellation Policy*Weather-Related Cancellations Class will be cancelled by 8a.m. the morning of the program if Duluth Public Schools (ISD 709) are cancelled due to snowy conditions or cold temperatures. Class will be cancelled by 8a.m. on the morning of the program if there is a 70% or greater chance of thunderstorms during class time according to Weather.com. If unsafe weather arises during class, we will take shelter indoors in a space that is separate from the general public (i.e. a classroom) until the weather passes or pick-up time, whichever comes first. We will wait 1/2-hour from the last time lightning is sighted to return outdoors. Class will be cancelled at least two hours prior to the program if the air quality index is greater than 201. If a class is cancelled due to weather, we make every effort to offer a make-up class. Make-up classes will be rescheduled for different week on the same day and time as your regular class. No refunds will be offered if a make-up class is offered. If a make-up class cannot be offered for any reason (i.e. space or staff availability), you will have the option to receive a full refund or donate the cost of the class to the Aquarium to support future educational programming. COVID-19 Related Cancellations In the event that Great Lakes Aquarium cancels class(es) due to a COVID-19 case, exposure or building closure, you will have the option to receive a full refund for the cancelled class(es) or donate the cost of the class(es) to the Aquarium to support future educational programming. Other Circumstances If you need to cancel your registration for any reason, the following policy applies. Great Lakes Aquarium will refund 50% of the program fee for cancellations made at least two weeks before the class. For cancellations made less than two weeks in advance, refunds will be considered on a case-by-case basis. Great Lakes Aquarium reserves the right to cancel this program in case of an insufficient number of participants or other unforeseeable circumstance. If this occurs, all registered families will be notified upon determination that the program has been cancelled, and a full refund will be issued for all registered participants. I have read and agree to the refund/cancellation policy.Are you the recipient of a Great Lakes Aquarium scholarship?*Scholarship recipients will have received an email containing their scholarship award letter. Yes No Kestrels Full Session - Scholarship Recipient*Please enter the dollar amount you will pay for Chickadees (found in your scholarship award letter). Kestrels Full Session - Member Rate* Price: Kestrels Full Session - Non-Member Rate* Price: (Become a Great Lakes Aquarium member today for a discounted rate!) I would like to make an additional donation to the Great Lakes Aquarium scholarship fund.These scholarships are available to families experiencing financial hardship who would like to participate in Aquarium programming. If you would like to contribute, please enter an amount of your choosing. Thank you for your donation! Total $0.00 Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Expiration Date Security Code Cardholder Name Billing Address Same as previous Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Hidden Validation Field