| PERSONAL
INFORMATION |
| Name (first,
last): |
_______________________________ |
| Street Address: |
_______________________________ |
| City, State,
Zip: |
__________ _____ ____________ |
| Country: |
_______________________________ |
| *E-mail
Address: |
_______________________________ |
| Home phone: |
(_____) _______________________ |
| Work phone: |
(_____) _______________________ |
| Fax: |
(_____) _______________________ |
| Cell Phone:: |
(_____) _______________________ |
|
ACTIVITY INFORMATION: |
Location
while on Vacation, Hotel name and phone number:
_______________________________________________________________________________________
Arrival & Departure
Date: _____/_____/_____ & _____/_____/_____
Which Dolphin
Workshop Program would you like to Participate in?:
_______________________________________________________________________________________
Number of
Participants: Adult______ & Child
_______
Date Requested: ____/____/_____
|
|
REQUIRED INFORMATION: |
List
Name and Ages (Miami program requires Height) of Participants:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
|
| Are You the
Parent/Guardian: |
_________ |
| Are all English speaking: |
_________ |
| Any health problem/physical
conditions: |
__________________________________________________ |
| Any allergies or aversion
towards cats: |
_________ |
| You understand
that transportation to the Program Location is needed: |
_________ |
Where
will you be
staying while
in Florida |
__ Ft. Lauderdale
__ Miami
__ Key West
__ Key Largo
__ Middle Keys
__ Orlando
__ West Palm Beach
__ Tampa Bay
__ Ft. Meyers
__ Other: _______________________ |
| Name
of Hotel or Residence you are staying |
_______________________________ (In
case of emergency) |
|
We may need to get in
touch with you while you are in Florida, if you don't know the
name of the hotel or residence where you are staying please put
your cell phone number here: __________________________ |
| PAYMENT INFORMATION |
| Type of Credit
Card: |
___________________________________ |
| Credit Card
Number: |
___________________________________ |
| Expiration
Date: |
__________________________ mm
/ yy |
| Card
ID Number: |
_______
American Express: 4
digits on front of card
Visa and MasterCard: 3 digits on back of card |
| Cardholder
Name: |
___________________________________ |
Refund Policy:
You understand that the cancellation policy is no later than
14 days prior to program date. However, a 10% service charge
will apply per person for any cancellations prior the 14 days.
A 20% service charge will apply per person for any cancellations
within 14 - 8-day period. NO REFUND WILL BE GIVEN TO ANY ACTIVITY
PARTICIPANTS who cancel within the 7-day period, do not show
up, or are late for scheduled program(s). Once a reservation
has been made, a change to the scheduled program date is subject
to availability. Changes will be subject to a $25 fee.
__ YES - I am over 18 years
of age.
|
|
Restrictions: “Participant
can not be pregnant”
Miami : All participants need to be at least 52 inches (132 centimeters)
tall for Dolphin Swim and 5 years old and up for the Dolphin Encounter
Florida Keys : Participant must be at least 5 years old and up
Mexico : Participant must be at least 8 years old and up
Dominican Republic : Participant must be at least 6 years old and
up |
|
Dolphin World Fax # 954-525-5057, Phone # 954-525-4441 |
