A separate form must be filled out for each child, including medical information. Incomplete forms will be returned for completion. Please complete both pages.

Camper Information
Child’s Name:
Grade Enrolledon April 10, 2017
Parent/Guardian Name:
Street Address:
City: / State: / Zip Code:
Parent’s Email Address:
Parent’s Daytime Phone:
Alternate Daytime Phone:
Camper Medical Information
Physician Name:
Physician Phone:
Alternate Emergency Contact:
Relationship:
Phone:
Health Restrictions:
Other Information We Should Know:
(Include separate attachment if needed)
Select Camp Days (please check all that apply):
AGES 6-11
/ Monday, April 10– Feet are Neat
/ Tuesday, April 11– Quite a Bite
/ Wednesday, April 12– Keen Eyes
/ Thursday, April 13– Clever Ears
/ Friday, April 14– Knowing Noses

Cost:

  • Daily Cost: Members - $75.00 per day per camper; Non-members - $90.00 per day per camper.
  • Or, Weekly Cost: Members - $300.00 per week; Non-members - $350.00 per week

Total Camp Fees: $______

Are you a Virginia Zoo Member?  Yes No

Membership Number: ______

Payment Method(please select one):

Check # ______MasterCardVisaAmerican Express

Credit Card #______Exp.______Signature______Total Fees: $______

Virginia Zoo Camp Registration – additional information (Please read, sign, and return)

To register, complete form and fax to (757)625-1061 or mail to VZS Education Dept., 3500 Granby Street, Norfolk, VA 23504, or email to: or drop off in person at the Membership Desk in the entrance building of the Zoo. Please call(757) 441-2374, ext. 229 with any questions.

Campers need to provide their own bag lunches. The zoo will provide daily snacks. All campers must wear closed-toe shoes and need to dress appropriately for outdoor activities and for the weather.

Registrations cannot be processed unless these forms are completed in their entirety, and payment is received in full. Upon receiving the forms, we will contact you by email to confirm your registration and provide you with further details of the camp. Space is assigned on a first-come, first-serve basis. If a camp is full, or if it is cancelled for any reason, we will inform you in a timely manner. If any session is cancelled, your payment will be refunded in a timely manner.

(There may be no refund if a child is asked to leave the program because of a serious discipline or behavior problem).

Please read and sign the following:

I give permission for my child to participate in the Virginia Zoo’s camp program. I understand that safety precautions will be taken during all activities. In the event that any accident does occur, I will not hold the City of Norfolk, the Virginia Zoological Society, their employees or volunteers responsible for any accidental injuries. I have read the registration information and have provided accurate medical information concerning my child. In the event of a medical emergency, if the parent, guardian, emergency contact, or designated physician cannot be reached, I authorize the Virginia Zoo to transport and/or obtain medical service from any physician for my child.

I understand that the age limit is based on my child’s current age at the time the camp is held. I know that I must bring a copy of my child’s birth certificate or other official document confirming his or her age on or before the first day of camp.

Name(s) of person(s) approved for camper pick-up:

______

Name(s) of anyone notallowed to pick up camper:

______

I have read and agree to the above policies.

Signature of Parent or Guardian______

Date______

3500 Granby Street | Norfolk, VA 23504 | (757) 441-2374 |