No-School-Day Camp, Junior Zoo Keeper & Cheetah Camp Registration Form
Advance registration is required; camps and classes fill on a first-come, first-served bases. Register by mail, by fax at 503-220-5712 or in person. No phone registrations are accepted. Mail with payment to: Registrar, Oregon Zoo, 4001 SW Canyon Rd, Portland, OR 97221. You will receive written confirmation. For more information, please call 503-220-2781. Please do not send your registration to the Oregon Zoo Foundation. The delay may cause you to be closed out of a class. Refunds, minus a 10% administration fee, are available if you cancel 5 working days before the program fee.
Parent Information
 
Parent/Guardian's Name: _______________________________ Address: _____________________________________________
City: _____________________________________ State: ______ Zip: ___________________
Phone (day): ___________________________ Phone (eve): ___________________________
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:
Kindergarten 4th Grade
1st Grade 5th Grade
2nd Grade 6th Grade
3rd Grade  
   
Please mark the dates you are registering for:
Junior Zoo Keepers
(5th & 6th graders only)
Cheetah Camp
(K-6th graders only)
Saturday 10/20 Sunday 10/14  
Saturday 11/17
 
 
   
 

Describe any allergies, medication, physical and/or social limitations that our staff should be aware of (use additional sheet if necessary) Please include any conditions that might require special planning or consideration for your child's participation in Zoo camp. Note: Oregon Zoo staff CANNOT dispense any medication. Parents must make arrangements. ________________________________________________________________________________________________

________________________________________________________________________________________________
In an emergency, if unable to contact parent, contact:
Name: ___________________________________ Day Phone: ____________________________________________
Please list the names of people authorized to transport your child _________________________________________
_______________________________________________________________________________________________
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: ____________________________________ Security Code ________ 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