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Sleep with Sharks Booking Form

 
  Preferred Date  
 
Date
 
   
  Applicant's Information  
 
Child's Personal Details
Name
Nickname
Date of Birth Age
Gender
Male Female
Contact Number
Email
Home Address
Address line 1
Address line 2
City
Postcode
State
Country
Health Condition
Allergies
Special Medications
Does the child have an asthma inhaler?
If Yes - Please ensure they bring their inhaler as it will not be provided in the programme
Yes
No
Other relevant information

 
   
  Emergency Contacts  
 
Emergency Contact 1In case of emergency, the name and phone number below are those to respond
Name
Contact Number
Relationship
Email
Emergency Contact 2
Name
Contact Number
Relationship
Email
 
   
  Acceptance  
 
I hearby declare that the information given in this form is true & correct, and understand what it says, and abide by the terms and conditions set here of. I understand that my application can be rejected inthe event that I have submitted incorrect and incomplete information with false document.

The child does not have any physical or mental conditions which would restrict or prevent * him / her from participatingin the scheduled activity, or which would increase the risk of harm.

As the legal guardian of the participant named above, I hereby give consent and permission to [participant's name above] to participate in the Sleep with Sharks Programme @ Aquaria KLCC and agrees to abide by theterms and regulations specified.
By checking this check box, I confirm that the information given is true & correct.
For more Information

The programme is only available on weekends and open to children aged 6 to 13 years only.
Due to the popularity of the programme, advance booking is recommended to ensure your place.

For further inquiries please call 03-23331976/1977/1971 or email marketing@aquawalk.com

Download our booking forms & fax them back to us at +603 2380 0069

Sleep With Sharks Programme Booking Form