Fossil Hunt Registration

Are you signing up as a volunteer and/or to attend the Advanced Eocene Fossil ID workshop (Ages 14+)?

Participant's Name *

First Name Last Name

Grade Level *

Age *

Additional Student's Name (optional)

First Name Last Name

Age *

Grade Level *

Additional Student's Name (optional)

First Name Last Name

Age *

Grade Level *

Are you members of the MESS Hall? *

Yes No

Which time? Please indicate the number of individual fossil trays you will need (parents can team with kids, older kids with younger, etc) *

Fossil Hunt is included with admission. Admission is $10 per person ages 3 and up, including adults. No child is admitted without an adult over 18.

Have you attended a program at the MESS Hall before? *

Yes No

Participating in the Advanced Eocene Fossil ID Workshop/Volunteer Training at 11:30AM, October 19, prior to Curiosity Day event? (Ages 14+) *

Parent/Guardian Information

Name *

First Name Last Name

Main Number *

Area Code Phone Number

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

E-mail *

Informed Consent and Acknowledgement

In consideration of my child’s participation in programs provided by the Pensacola MESS Hall, I indemnify and hold Pensacola MESS Hall and its affiliates, employees and agents harmless from and against any and all liability for negligence or medical expenses resulting from my child’s participation in such programs or other activities. I further release Pensacola MESS Hall and its affiliates, employees and agents from any and all negligence or other claims resulting from my child’s participation. I further understand that Pensacola MESS Hall does not provide medical insurance coverage for my child and that any medical expenses incurred will be paid by either my own medical insurance or myself. I hereby grant permission for my child to participate in all activities.

I give permission for my child’s photo and/or likeness to be retained and used by Pensacola MESS Hall without any remuneration or compensation.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.