Example Claim Form. Actual form must be downloaded and printed before completing and mailing claim.

Parrot Island Class Action Settlement Claim Form

Case No. 66FCV-24-562

• Claimant Information (all must be completed)(form must be signed and dated)

Full Name:                                                                                                                                  example                                

Mailing Address:                                                                                                                                                                            

City, State, Zip:                                                                                                                                                                                

Phone Number:

Email Address:                                                                                

• Claimant’s Purchase Information

Date(s) of Purchase:                                                                                                        example                                                            

Number of Tickets Purchased:                                                                                                                                                

Total Amount Paid:                                              Type of Payment: □ Cash     □ Credit     □ Online     □ Other

• Proof of Purchase (select all that apply and attach/include proof with claim form)

□ Receipt (physical or digital printout)

□ Bank or Credit Card Statement (purchase amount highlighted)

□ E-Ticket or Printed Ticket

□ Order Confirmation Email

□ Membership Record or Season Pass

□ Photos from Day of Visit (with date stamps or metadata showing visit date)

□ Claimant did not retain proof of purchase

□ Other:                                                                                                                                                                                             

• Additional Information (Optional)(Attach additional page if needed)

example

I hereby attest under penalty of perjury that the statements and attachments made with this claim are true and complete to the best of my knowledge. I understand that the use of US Mail to file a fraudulent claim may hold additional penalties.

Signature:  example                                                                                                                                   Date:  example