Interns

CAMP REGISTRATION FORM

Please check all that apply:

FOSZ member (Family level or above)
Registering a Sibling
Registering for multiple sessions
Repeat Camper

Session Number(s)*

Camper's First Name*

Camper's Last Name*

Camper's Nickname

Address*

City, State, Zip*

Home Phone*

Email*

Camper's Date of Birth*

Age*

Gender*

Male
Female

Campers T-Shirt Size*

Guardian's Full Name*

Daytime Phone*

Please specify any allergies, physical or social limitations and current medications:

Emergency Contacts

In case of emergency, when a legal guardian cannot be reached, please list the names and telephone numbers of TWO adults that should be called:

#1 Name*

#1 Phone*

#2 Name*

#2 Phone*

Payment Details

Credit Card Type*

Amount*

Card Number*

Security Code*

Expiration Date*

Name on Card*

Waiver and Photo Release

I certify that the camper has my permission to participate in ZooCamp sponsored
by Salisbury Zoological Park. I hereby relieve the Salisbury Zoological Park,
its staff and instructors from any responsibility for any bodily injuries, etc...
incurred by my child as a result of perticipation in this activity.

The Salisbury Zoo has my permission to use photographic images of my child
engaged in activities at the Zoo in any promotional print publications, exhibits
or on the Salisbury Zoo website.

I Authorize Salisbury Zoological Park to Charge my Credit Card.

Signature
Please type your full name in the box below.
This digital signature constitutes your true signature and carries with it all of the strength of a true signature.

Digital Signature*

Date

For more information call The Salisbury Zoo at 410-860-6880, ext. 8

Email: ldillon@ci.salisbury.md.us

Interns

Salisbury Zoological Park

E-News: