Camper Registration Form

Form for collecting individual camper information

Section 1 - Order Information

The information you are about to enter helps us match each registration to each camp reservation so that we know who to expect on the first day and who still needs to complete registration

Name(Required)

First Last

Please enter the name of the person who placed the order and made the reservation

Email(Required)

Please enter the email used to place the order and make the reservation

Order Number

Please enter order number for the reservation. This is a 6 digit number found just under the QR code on your emailed receipt.

Section 2 - Camper Information

The following information is about a specific camper. If you are completing registrations for multiple campers, you must complete this form separately for each one

Camper's Name(Required)

First Last

Please enter the name of the Camper as entered on the Waiver

Nickname

If the camper prefers to go by a nickname, please enter it here

Birthday(Required)

MM slash DD slash YYYY

Please enter the campers date of birth

Section 3 - Reservation Confirmation

Which camp did you register for?(Required)

Little Lemurs (1st and 2nd Grade)

Party Parrots (3rd and 4th Grade)

Little Lemurs Camp Date(Required)

July 13-17

July 27-31

August 10-14

Please select the Date(s) this camper is registered for

Party Parrots Camp Date(Required)

June 22-26

July 6-10

July 20-24

August 3-7

August 17-21

Please select the Date(s) this camper is registered for

Section 4 - Parent, Emergency Contact, and Approved Pick-up Information

Primary Parent / Guardian Name(Required)

First Last

This is the parent / guardian who will be contacted first while your camper is at Cougar Mountain Zoo

Primary Parent / Guardian Phone(Required)

Please enter the phone number for the Primary Parent / Guardian

Secondary Parent / First Emergency Contact Name(Required)

First Last

This is the next person to be contacted should the primary not be reached at the above phone number

Secondary Parent / First Emergency Contact Phone(Required)

Please enter the phone number for the Secondary Parent / Emergency Contact

Would you like to provide an additional Emergency Contact?(Required)

Yes

This is optional, but recommended. This person will be contacted should the Primary Parent / Guardian and First Emergency Contact not be reached by phone

Additional Emergency Contact Name(Required)

First Last

This person will be contacted should the Primary Parent / Guardian and First Emergency Contact not be reached by phone

Additional Emergency Contact Phone(Required)

Please enter the phone number for the Additional Emergency Contact

Is there anyone not listed as a parent / guardian or emergency contact you would like approved to pick up your camper?(Required)

Yes

Additional Approved Pickup Name(Required)

First Last

Please enter the name of the additional pickup person - ID will be required at pickup

Section 5 - Camper Medical Information

This information is used to set your camper up for success and allow us to respond appropriately in the event of an emergency

Has your camper been diagnosed with or showing signs of any Behavioral / Emotional health concerns?(Required)

Yes

i.e. Anxiety, Depression, ADD/ADHD, Autism, etc.

Behavioral / Emotional Detail(Required)

Please provide more detail and tips that will help us ensure your camper has a great time at camp.

Has your camper been diagnosed with or showing signs of any of the following?(Required)

Auto-immune disease or disorder

Diabetes

Frequent and/or severe nose bleeds

Hearing Condition

Incontinence

Recent Injury

Other not listed

None

Medical Detail(Required)

If you selected any of the above, please provide more detail.

Does your camper have any severe / acute allergies?(Required)

Yes

Please do not select Yes for seasonal or environmental allergies (i.e. pollen, grass, dander) whose symptoms are well managed. Do select Yes for seasonal of environmental allergens that lead to rash, shortness of breath, swelling, or vomiting. Select Yes for any allergies that have produced an anaphylactic reaction.

Allergy Details(Required)

Please provide details for any allergies effecting your camper. Be as detailed as possible

Will your camper be bringing any medication to Cougar Mountain Zoo (including inhalers and EpiPens)?(Required)

Yes

Cougar Mountain Zoo Medication Policy

In order to ensure the health and safety of all program participants, we do not allow children to carry medications on their person or keep in a backpack throughout the day. Instead, medications must be checked in at drop-off and checked-out at pick-up, with the exception of EpiPens and inhalers.

EpiPens and Inhalers

Parents and guardians may elect for children to self-carry Epi Pens or inhalers or may check them in like other medications. If parents choose to allow children to self-carry, Cougar Mountain Zoo is not responsible for the loss or damage of the EpiPen or inhaler.

Administration

Any medication that a child will take during their time at Cougar Mountain Zoo will be administered by the program manager or most senior program staff on site. Administration will match the dosage, timing, and method of administration prescribed below.

Limits to scope of administration

Cougar Mountain Zoo reserves the right to not administer any medication if staff do not possess adequate skill or knowledge (e.g. giving injections without the child's assistance and more). In this case, the parent will be contacted in advance of the camp session to discuss options of how to move forward.

Consent(Required)

I agree to the above Medication Policy

By checking this box, you are agreeing to Cougar Mountain Zoo's Medication Policy for campers

Medication Details(Required)

Please list medication(s), dosage, method of administration, and time(s) of administration

Section 6 - Code of Conduct

By completing this registration paperwork, you and your camper agree that your camper will abide by the Cougar Mountain Zoo Camp Code of Conduct. Cougar Mountain Zoo is dedicated to providing an outstanding camp program. To accomplish this, campers are expected to behave appropriately and promote a safe, fun, and healthy environment through productive participation. We aim to promote character values of caring, honesty, respect, and responsibility in all aspects of our camp program. We ask that all campers and parents / guardians read this code together before arriving to camp. The Cougar Mountain Zoo Camp Code of Conduct was included in the original email sent after registration. It will be sent again 1 week prior to your camp date.

Consent(Required)

I agree to review the Code of Conduct with my camper prior to the start of camp

By checking this box, you are agreeing to review the Cougar Mountain Zoo Camp Code of Conduct with your camper prior to the start of camp. You also agree that any violations of the Code of Conduct can be grounds for automatic dismissal. Refunds are not given when a camper is dismissed from a camp program.

Section 7 - You did it!

Thank you for taking the time to fill out this registration form and ensure your camper is set up for a successful, fun time at camp! If you have any additional information to help us do our part to provide a great experience, please use the comment box below. If anything changes between the completion of this form and the start date of your camp, please do not hesitate to reach out to us!

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