Summer Camp Registration

ATTENDEE INFORMATION (one form per child)
Child's name:
Nickname:
Birthdate:	(MM/DD/YY)
Sex:	Male Female
Allergies, limitations, medications:
T-shirt (limit 2 free t-shirts per camper):
Number of Extra t-shirts:	Qty ($10 per shirt )
Parent/Guardian Name:
Address:
City:
State:
Zip:
Email:
Home Phone:
Work Phone:
Cell Phone:
Member of the Zoo:	Yes No
Member Number:
CAMP INFORMATION (Refer to brochure for #s and names)
Session #:
Camp Name:
Date:	(mm/dd/yy)
Time:
Fee:
Session #:
Camp Name:
Date:	(mm/dd/yy)
Time:
Fee:
Session #:
Camp Name:
Date:	(mm/dd/yy)
Time:
Fee:
Session #:
Camp Name:
Date:	(mm/dd/yy)
Time:
Fee:
Before Camp Care:
Afternoon Extended Care:
Conservation & Science buttons:	Qty ($2 each)
If purchasing more than four camps, please complete an additional form.
Total:
PAYMENT INFORMATION
Card Type:
Card Number:
Expiration:	(mm/yy)
Security Code: (last three digits on back of card)
Total amount paid:
EMERGENCY INFORMATION (this person to be contacted if the parent or guardian cannot be reached)
Name:
Relationship:
Daytime Phone: