Use a separate form for each child. Duplicate this form as needed. Payment must accompany this form!
| Directions: Write a number in the boxes indicating your first , second and third choice. Children entering sixth through eighth grade may register for one week each of AIC and Wild Science. See Registration Procedures for additional instructions. Make checks payable to : Oregon Zoo |
||||||||||
|
Penguin |
Tiger |
Giraffe |
Rhino |
Safari |
Animal |
Wild |
Check boxes |
|||
| A.M. |
P.M. |
|||||||||
| Week 1 June 19 - 23 |
q Zoo Lunch ($20/week) |
|||||||||
| Week 2 June 26 - 30 |
q Early drop off ($20/week) | |||||||||
| Week 3 *July 5 - 7 |
q Late pick up ($32/week) |
|||||||||
| Week 4 **July 10 - 14 |
q Early drop off / Late pick up ($52/week) | |||||||||
| Week 5 July 17 - 21 |
Scholarship fund donations $ __________ |
|||||||||
| Week 6 July 24 - 28 |
Camp fees $__________ |
|||||||||
| Week 7 July 31 - Aug. 4 | ||||||||||
| Week 8 **Aug. 7 - 11 | ||||||||||
| Week 9 Aug. 14 - 18 |
||||||||||
| Week10 Aug. 21 - 25 |
||||||||||
| Week 11 Aug. 28 - Sept. 1 | Total Enclosed $ __________ |
|||||||||
* Short week with reduced rate
** Free Tuesday Alert: You may pick up your child early to avoid the heavy traffic which may begin at noon on Tuesday 7/11 and 8/8
Camper's Name _________________________________________ Age ______ Birthdate _____/_____/_____
Parent/Guardian Name ____________________________________
Address ______________________________________ City ____________________ State ____ Zip ________
Day Phone(s) __________________________________ Evening phone(s) ____________________________
Zoo Membership Expiration Date: _____________________
Charge Card #__________________________________ Signature ___________________________________
Exp. Date _____/_____
T-Shirt: Fees include 1 T-Shirt per camper. Circle size. Order the size your child will wear during camp.
Child sizes: S(size 6-8) M(size 10-12) L(size 14-16)
Adult sizes: S(size 34-36) M(size 38-40) L(size 42-44) XL(size 46-46)
_________________________________________________________________________________________________
Please list any health problems or physical conditions that might require special planning or consideration for your child's participation in Zoo Camp.
Note: Oregon Zoo staff WILL NOT dispense any medication. Arrangements must be made by parents.
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Emergency contact, if unable to contact parent: Name _________________________________ Phone _______________
My child has permission to participate in all camp activities. I authorize Oregon Zoo to use my child's name and photograph for education and public
relations purposes related to the Zoo. Any contrary directions will be specified and signed on a separate sheet.
Legal Parent/Guardian: _________________________________________________ Date:_______________________
Carpooling? List the names of persons authorized to transport your child:
_________________________________________________________________________________________________
_________________________________________________________________________________________________