Dreamnight at the Zoo 2026 Registration

Your Contact Information

First Name *

Last Name *

Email *

Address Line 1 *

Address Line 2

Phone *

City *

State *

Zip *

Patient Information

Please provide patient information below.

Child's Name * The field Child's Name is required.

Child's Age * The numeric field Child's Age is required.

Patient DOB * The date field Patient DOB is required.

Patient Diagnosis * The field Patient Diagnosis is required.

Patient Deceased * The field Patient Deceased is required.

Patient Current Treatment Status * The field Patient Current Treatment Status is required.

Current Shirt Size * The field Current Shirt Size is required.

Special Notes, Questions or Concerns: The maximum length for the field Special Notes, Questions or Concerns: is 5000 characters.

Guest Information

Provide guest information below. Each patient is allowed a maximum of 7 guests.
***T-SHIRTS WILL BE PROVIDED FOR PATIENTS AND SIBLINGS ONLY.***
Please indicate preferred T-shirt size of patient and siblings below. While we will make every effort to honor T-shirt size requests, sizes cannot be guaranteed.

Number of guests of patient * The field Number of guests of patient is required.

Guest #1 Name * The field Guest #1 Name is required.

Guest #1 Relationship to Patient * The field Guest #1 Relationship to Patient is required.

Guest #1 Shirt Size * The field Guest #1 Shirt Size is required.

Guest #2 Name The maximum length for the field Guest #2 Name is 500 characters.

Guest #2 Relationship to Patient The maximum length for the field Guest #2 Relationship to Patient is 500 characters.

Guest #2 Shirt Size

Guest #3 Name The maximum length for the field Guest #3 Name is 500 characters.

Guest #3 Relationship to Patient The maximum length for the field Guest #3 Relationship to Patient is 500 characters.

Guest #3 Shirt Size

Guest #4 Name The maximum length for the field Guest #4 Name is 500 characters.

Guest #4 Relationship to Patient The maximum length for the field Guest #4 Relationship to Patient is 500 characters.

Guest #4 Shirt Size

Guest #5 Name The maximum length for the field Guest #5 Name is 500 characters.

Guest #5 Relationship to Patient The maximum length for the field Guest #5 Relationship to Patient is 500 characters.

Guest #5 Shirt Size

Guest #6 Name The maximum length for the field Guest #6 Name is 500 characters.

Guest #6 Relationship to Patient The maximum length for the field Guest #6 Relationship to Patient is 500 characters.

Guest #6 Shirt Size

Guest #7 Name The maximum length for the field Guest #7 Name is 500 characters.

Guest #7 Relationship to Patient The maximum length for the field Guest #7 Relationship to Patient is 500 characters.

Guest #7 Shirt Size

Photo Waiver

Effective as of the date shown below, approval for past use and permission for present and future use is being granted to Dream Day Foundation, 1165 S. Foster Drive, Baton Rouge, LA 70806 to use photographs or other images taken from June 5, 2026 of the Photographed Party, as more fully explained in this Consent and Release. The Photographed Party is an individual adult, parent or guardian and is fully authorized to sign this Consent and Release. For value received, receipt of which is hereby acknowledged, the Photographed Party hereby grants consent to Dream Day Foundation, its agents, employees, licensees, and successors in interest (collectively, the Released Party) and authorize the use of any and all photographs taken of me, and any reproduction of them in any form in any media whatsoever and in any derivative work based thereon throughout the world, and to use them to publicize, promote and advertise, including but not limited to use for point of sale advertising. The Photographed Party also consents to the use of my own name or any fictitious name which may be chosen in connection with the aforesaid photographs. The Photographed Party hereby releases any and all claims whatsoever in connection with the use of my photograph and name and the reproduction thereof as aforesaid. The Photographed Party hereby waives any right that I may have to inspect and/or approve the Book or the advertising copy that may be used in connection therewith or the use to which it may be applied. THE PHOTOGRAPHED PARTY WARRANTS THAT YOU ARE THE UNDERSIGNED AND THAT YOU HAVE READ THIS CONSENT AND RELEASE PRIOR TO THE SIGNING OF THIS DOCUMENT, THAT THE UNDERSIGNED UNDERSTANDS IT, AND THAT THE UNDERSIGNED FREELY ENTERS INTO THIS CONSENT AND RELEASE.

Patient/Family Photo Waiver * The field Patient/Family Photo Waiver is required.

Document

DreamnightFlier_Invite (1).pdf