REGISTRATION FORM 2021 Please complete all applicable sections (2 pages). Please Print! Important Registration Information – PLEASE READ • A separate form is required for each camper (photocopies are fine). • There are two ways to register: on-line at www.rwpzoo.org (opens Wednesday, March 3rd at 9:30 am) or by mail (by printing registration form from online). On-line registration is strongly recommended. • Dropping off or mailing in a registration right away will not guarantee you a spot. • We cannot reserve space without full registration form and fee. • Mailed registrations will not be accepted without a completed Camper Personal and Medical Information Form. • Non-members: Sign up for membership with RI Zoological Society and register at member rate (verification required). • We reserve the right to cancel a week of camp if minimum registration requirements are not met. • Please make checks payable to: RI Zoological Society. • Complete refunds minus a $25 processing fee will be given up to February 1, 2021 for Winter Camps, April 1, 2021 for Spring Camps and June 1, 2021 for Summer Camps. • *****Absolutely NO refunds will be given after those dates. Registration Questions? Contact (401) 785-3510 x 358 or [email protected] for more information. CAMPER INFORMATION Membership #: _____________________________ (Must be provided to get member rate) Parent/Guardian Contact for Registration (First and Last Name):_____________________________________ Primary Contact E-mail: ___________________________Secondary E-mail (optional): ___________________ Camper’s Name (Last): ______________________________ (First):__________________________ Date of Birth: ___/___/____ Gender: M or F Office Use Only Address: ____________________________________ City: _________________ State: _____ Zip: ________ Parent Contact Home #: (____)_______________ Work #: (____)________________Cell #: (____)_________________ T-Shirts: Camp registrations include one complimentary t-shirt (for full week registrations only). Please indicate camper’s shirt size below: Child: XSmall (4-5) Small (6-8) Medium (10-12) Large (14-16) Adult: Small Medium Large XLarge Summer Adventures - Ages 6-10 Summer Adventures 7:40 AM – 3:30 PM Mon-Fri # of Summer Adventures Weeks: (Ages 6-10) Members: $280 Non-members: $305 Odd Weeks: Stayin’ Alive: Animals in the food chain do everything they can to stay alive. Over time, many have developed amazing adaptions that keep them from becoming the next item on the menu. Some have cleaver camouflage; some have built in armor, and others even sacrifice body parts! Even Weeks: Wild World of Reptiles: Reptiles rock! Shockingly divers, turtles, tortoises, lizards, snakes, alligators, crocodiles, and the rare tuataras are all reptiles but different in their won way. We’ll uncover the characteristics all reptiles share before exploring each group and what makes them unique. Please number your first, second and third choice of sessions. There is a maximum of one week per theme. SA Week 1: 06/14– 06/18 Stayin’ Alive SA1 SA Week 2: 06/21 – 06/25 Wild World of Reptiles SA2 SA Week 3: 06/28 – 07/02 Stayin’ Alive SA3 SA Week 4: 07/05 – 07/09 Wild World of Reptiles SA4 CH Week 5: 07/12 – 07/16 NO ADVENTURES-Conservation Heroes Only CH1 SA Week 6: 07/19 – 07/23 Wild World of Reptiles SA6 SA Week 7: 07/26 – 07/30 Stayin’ Alive SA7 SA Week 8: 08/02 – 08/06 Wild World of Reptiles SA8 SA Week 9: 08/09 – 08/13 Stayin’ Alive SA9 CH Week 10: 08/16 – 08/20 NO ADVENTURES-Conservation Heroes Only CH 2 CONSERVATION HEROES – NOW Ages 11-14! Conservation Heroes 7:40 AM – 3:30 PM Mon-Fri (Ages 11-13) Members: $280 Non-members: $305 July 12th-16th Dirty Jobs: The world of conservation is full of dirty jobs, but it’s also full of passionate people willing to do them in order to accomplish amazing things for our environment, communities and animals. These Conservation Heroes are active everywhere, from the far side of the globe to right here in our back yard! We’ll learn about champions of local conservation, animal welfare, climate change and more … and maybe get a little dirty in the process. August 16th-20th ZooMysteries: Calling all sleuths! The natural world is full of mysteries, and for each one solved another dozen remain. From answering the whys and hows of crazy adaptations to looking at new animal discoveries and more, we will examine recently solved mysteries, explore those that remain unanswered and maybe discover a few more in the process! Curiosity required. CH Week 1: 07/12 – 07/16 Dirty Jobs CH1 CH Week 2: 08/16 – 08/20 ZooMysteries CH2 FINAL INFORMATION & PAYMENT FORM Camper’s Name (Last): __________________________ (First):______________________ Payment ADVENTURES Quantity Cost Amount Due Winter Adventures (# of days) x = Spring Adventures x = Summer Adventures x = CONSERVATION HEROES Conservation Heroes x = ADD-ONS (please contact (401) 785 -3510 x358 if registering for less than a full week of Winter Adventures and interested in add-ons) Extra T-Shirts x $12 = Week of Lunches (You will be x $40 = contacted to select lunch choices) 1 Week of After Care x $60 = New this year! Due to current restrictions, After Care will not be able to be added during the camp week to keep consistent stable groups within camp. Campers can only sign up for the full week of After Care. Total Amount Due = Payment Type Check Number: Please make checks out to RIZS Circle Credit Card: Am. Express Discover Visa MasterCard Charge Amount: Security Code: Credit Card #: Exp. Date: Name (as appears on card): Billing Address: Signature: All Done? Be Sure to Include: Mail To: Registration form for each participant – pages 1 - 2 Roger Williams Park Zoo ATTN: Education Department Zoo Camp Registration Full Payment 1000 Elmwood Ave Camper Personal & Medical Information Form for each Providence, RI 02907 participant .