Zoo Summer Camp Registration: Grades 4-5

Child's First Name *

Child's Last Name *

Child's Date of Birth *

T-shirt Size *

Parent Name *

Address *

City / State / Zip Code *

Email *

Member's Name & Exp.

Allergies *

Prescribed Medications *

Physical/Mental/Emotional Special Needs *

Health Restrictions or Developmental Conditions *

Other *

Parent/Guardian Cell Phone or Work Number *

Emergency Contact Name *

in case parent/guardian cannot be reached:

Emergency Contact Relationship *

Emergency Contact Phone *

Authorized Pick-Up Name *

For multiple authorized pick-ups, please add commas in between names.

Authorized Pick-Up Relationship *

For multiple authorized pick-ups, please add commas in between relationships.

Number of Sessions and Membership Status *

Camp Sessions (Please check all that you would like to sign up for) *

June 17 - 21: Daring Detectives

June 24 – 28: Wild Wizards

July 8 – 12: Habitats and Hideaways

July 15 – 19: Earth Explorers

July 22 – 26: Daring Detectives

July 29 – August 2: Wild Wizards

August 5 - 9: Habitats and Hideaways

August 12 – 16: Earth Explorers

August 19 - 23: Daring Detectives

Before Camp Childcare Program (Please check all that you would like to sign up for)

June 17 - 21: Daring Detectives, +$20.00

June 24 – 28: Wild Wizards, +$20.00

July 8 – 12: Habitats and Hideaways, +$20.00

July 15 – 19: Earth Explorers, +$20.00

July 22 – 26: Daring Detectives, +$20.00

July 29 – August 2: Wild Wizards, +$20.00

August 5 - 9: Habitats and Hideaways, +$20.00

August 12 – 16: Earth Explorers, +$20.00

August 19 - 23: Daring Detectives, +$20.00

After Camp Childcare Program (Please check all that you would like to sign up for)

June 17 - 21: Daring Detectives, +$25.00

June 24 – 28: Wild Wizards, +$25.00

July 8 – 12: Habitats and Hideaways, +$25.00

July 15 – 19: Earth Explorers, +$25.00

July 22 – 26: Daring Detectives, +$25.00

July 29 – August 2: Wild Wizards, +$25.00

August 5 - 9: Habitats and Hideaways, +$25.00

August 12 – 16: Earth Explorers, +$25.00

August 19 - 23: Daring Detectives, +$25.00

BOTH Before and After Camp Childcare Program

June 17 - 21: Daring Detectives, +$40.00

June 24 – 28: Wild Wizards, +$40.00

July 8 – 12: Habitats and Hideaways, +$40.00

July 15 – 19: Earth Explorers, +$40.00

July 22 – 26: Daring Detectives, +$40.00

July 29 – August 2: Wild Wizards, +$40.00

August 5 - 9: Habitats and Hideaways, +$40.00

August 12 – 16: Earth Explorers, +$40.00

August 19 - 23: Daring Detectives, +$40.00

ADD ON: Spring Break Camp April 1 - 5 (K-5)

No Thank You

Full Day Camp - Member Rate, +$200.00

Full Day Camp - Non-Member Rate, +$225.00

ADD ON: Spring Break Camp Childcare Options

No Thank You

Before Camp Care Only (7:30am – 9am), +$20.00

After Camp Care Only (4pm – 6pm), +$25.00

Both Before and After Childcare, +$40.00

Optional Extras

I would like to contribute to the Zoo's Campership Fund for children in need of financial assistance.

Did you complete and sign the Camp Policies and Release Form? *

See above in red.

Signature of Parent/Guardian *

Zoo Summer Camp Registration: Grades 4-5

Camp Details:

Racine Zoological Society

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