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Have the most unique Valentine's Day of your dreams with animal encounters in a relaxing, intimate night on the farm! Meet our emu, wallaby, baby animals, and more! $80 for a couple BYOB snacks and drinks, alcohol is permitted we just ask for no glass bottles 21+ yrs old is required to attend A minimum of six people is required to run the event Due to being an indoor facility we plan to host the event rain or shine Contact Hannah at 508-654-5958 for any questions!
Event:
Start Date/Time:
End Date/Time:
Fee per Family:
Room:
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- denotes required fields
Family Information
First Name:
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Last Name:
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Type
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Caregiver
Father
Guardian
Mother
Parent
Self
Home Phone:
Cell #:
Work #:
Email:
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(Emails are kept confidential)
Address:
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City:
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State:
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AK
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DE
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ID
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Zip:
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Add New Student #1:
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Student's First Name:
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Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
Disabilities :
*
Allergies :
*
Permission to Photograph :
*
Add New Student #2:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
Disabilities :
*
Allergies :
*
Permission to Photograph :
*
Add New Student #3:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
Disabilities :
*
Allergies :
*
Permission to Photograph :
*
Add New Student #4:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
Disabilities :
*
Allergies :
*
Permission to Photograph :
*
Add New Student #5:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
Disabilities :
*
Allergies :
*
Permission to Photograph :
*
Questions/Options:
Names and ages of participants
*
Do you plan to bring any food or drinks?
Yes
No
Favorite animal?
Additional Information:
Other Questions/Comments:
Credit Card Verification:
Card Number:
*
Visa
Mastercard
Amex
Discover
Name as it appears on card:
*
Nickname:
Card Expiration Month:
*
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Exp Year:
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2025
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Address Line 1:
Address Line 2:
City:
State:
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
PR
VI
Zip:
*
eCheck/Bank Draft:
Bank Name:
Bank Routing Number:
(9-digit number)
Your Account Name:
(Your name on your bank statement)
Your Account Type:
Checking
Savings
Account Number:
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