ZooVenture Day Camp Registration Form

Parent Information

 
Parent/Guardian's Name: _______________________________ Address: _____________________________________________
City: _____________________________________ State: ______ Zip: ___________________
Phone (day): ___________________________ Phone (eve): ___________________________
Fax: ___________________________
Are you an Oregon Zoo Member? _____No    _____Yes     If yes, what is your member number? _____________________
If you would like to be an Oregon Zoo member, please call (503) 220-2493 for more information.

Child/Camp Information

Child's Name: _______________________________________ Date of Birth: ______/______/______

Age Group:
Penguin (4yrs - Kindergarten)
Select Session: AM PM
Tiger (1st Grade)
Giraffe (2nd Grade)
Rhino (3rd Grade)
Please mark the date (and daycare) you are registering for:
Zoo Venture Date:
Early Drop Off
($4/day 8:00-9:00am)
Late Pick Up
($8/day 4:00-6:00pm)
Monday 3/22
Tuesday 3/23
Wednesday 3/24
Thursday 3/25
Friday 3/26

Describe any allergies, medication, physical and/or social limitations that our staff should be aware of (use additional sheet if necessary)______________________________________________________________________________________
_______________________________________________________________________________________________

Please list any health problems, physical or behavioral 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. Parents must make arrangements. ________________________________________________________________________________________________
________________________________________________________________________________________________

In an emergency, if unable to contact parent, contact:
Name: ___________________________________ Day Phone: ____________________________________________

My child has permission to participate in all camp activities. I authorize Oregon Zoo to use local emergency services in order to secure proper treatment for my child named above.

I also consent and authorize the Oregon Zoo to use my child's name and photograph for education and public relations purpose related to the Zoo. Any contrary directions will be specified and signed on a separate sheet.
Legal Parent/Guardian: ____________________________________ Date: _______________________________

Payment Information
Tax deductible donation for Tuition Assistance program:
$__________ 
Total Camp Cost
$__________ 
Total Amount Enclosed
$__________ 
Make checks payable to Oregon Zoo. Payment enclosed: Check Visa MC AMEX
 Name as it appears on charge account: ___________________________________________________
Account Number: ____________________________________ Expiration Date: ___________________

In the event that my class choice is full, I would prefer: (select one only)
to keep a class credit on file a cash refund by mail