Lake Superior Zoo School 2021-2022 School Year Session Application
When: September 7, 2021 - June 9, 2022
Time: 7:30 AM - 5:30 PM
Who: Children ages 33 months-5 years (Must be 33 months old by Sept 7, 2021 and fully potty trained)
Where: Lake Superior Zoo, 7210 Fremont St, Duluth, MN 55807
Cost: $900/month (M-F); $540/month (MWF); $360/month (TTh)
Contact Leah Budnik at lbudnik@lszoo.org or (218) 730-4500 ext. 219 with questions or concerns.
Note: This application is not complete until the non-refundable application fee of $25 is received. Completion of this application does not guarantee enrollment.
Email address *
Child's First & Last Name *
Child's Date of Birth (Child must be 33 months old by September 7, 2021): *
MM
/
DD
/
YYYY
What is your preferred schedule of care? (check all that apply) *
Required
Child's Gender *
Child's preferred pronouns
Clear selection
Child's race/ethnicity (check all that apply) *
Required
Parent or Guardian's First & Last Name (1) *
Parent or Guardian's Relation to child (1) *
Parent/Guardian (1) Street Address, City, State Zip/Post Code *
Parent/Guardian (1) Primary Phone Number *
Parent/Guardian (1) Secondary Phone Number
Parent or Guardian's First & Last Name (2)
Parent or Guardian's Relation to child (2)
Parent/Guardian (2) Street Address, City, State, Zip/Post Code (if different than Parent/Guardian 1)
Parent/Guardian (2) Primary Phone Number
Parent/Guardian (2) Secondary Phone Number
Please share your child's strengths/passions *
List your child's allergies/dietary restrictions (please specify) *
List your child's special educational needs, health needs, or accommodation needs, if any *
Does your family qualify for financial aid programs such as the Child Care Assistance Program or Early Learning Scholarships? https://www.parentaware.org/learn/paying-for-care-and-education/ *
How did you hear about the Lake Superior Zoo School? *
RELEASE, INDEMNIFICATION AND WAIVER FORM (This is a release – please read carefully)
RELEASE, INDEMNIFICATION AND WAIVER FORM:
I, the undersigned, hereby acknowledge that I have been advised and fully understand that certain elements of danger are inherent in the activities sponsored by the Lake Superior Zoo School which are beyond the control of the instructors, agents, officers, students, and employees of the Lake Superior Zoo, and that participation in any program activities may entail unavoidable risk of personal injury, death, and loss of or damage to property. These risks include, but are not limited to insect and animal bites and stings, forces of nature such as but not limited to lightning, and unexpected extreme weather conditions, and any hazard present in the wilderness, such as but not limited to low lying branches, sharp objects, and slippery surfaces.
I hereby assume all risks of injury and death to the participant and loss of or damage to property arising out of participation in such activity and I agree to indemnify, hold harmless the Lake Superior Zoo, Lake Superior Zoological Society, and City of Duluth, its agents, officers, instructors, board members, employees, and representatives (“Releasees”) from and against all claims arising from any occurrence causing damage or injury to myself or to any party participating in said event or any third parties injured as a result of my actions. I further agree to repair or reimburse the Lake Superior Zoo for any and all damages that I cause to the property at which a specific activity is held.
Prior to signing below, I have read and understand the terms and conditions of this Release, Indemnification, and Waiver. I understand by signing below I am waiving certain legal rights I may have against the Releasees, and I agree to subscribe to all the terms and conditions set out above.


PHOTO/VIDEO RELEASE:
By checking the box below, I do hereby authorize the Lake Superior Zoo, and those acting pursuant to its authority to:
a. Record my child’s participation and appearance on video tape, audio tape, film, photograph or any other medium.
b. Exhibit or distribute such recording in whole or in part without restrictions or limitation for any educational or promotional purpose which the Lake Superior Zoo, and those acting pursuant to its authority, deem appropriate.
Agreement to the terms and conditions above *
Required
By checking the box below, I acknowledge that typing my name below constitutes my online signature and is as legally binding as such. *
Required
Please type your name as your signature *
Payment
The application fee is $25 per child and is non-refundable. To pay online with a credit card, please return to the "Lake Superior Zoo School" webpage and click the "Pay now" button. If paying by check, make your check payable to Lake Superior Zoo and mail it to 7210 Fremont St, Duluth, MN 55807. Please include a memo of the child's name with the check.
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy