Reid Park Zoo Waiver Form

Health, Emergency Contact and Waiver of Liability Form- SUMMER

This must be filled out by the parent/guardian of any camp participant AFTER you have registered for camp. AOL AND YAHOO EMAIL USERS - Please note that this form may not send correctly from these accounts. Please call 837-8090 to confirm we have received your form if using an AOL or YAHOO email. Thank you!

Health, Emergency Contact and Waiver of Liability Form - Summer Camp
Camp Participant's Name*
First Last
Camper's Gender
Camper's Age
Camper's Race/Ethnicity (optional)
This information is used to understand Reid Park Zoo's diversity within the summer camp program and to assist in obtaining future grants for camp scholarships.
Grade Your Camper will Enter in the Fall*
Week Participant Will Attend Camp
Days Participant Will Attend Camp
Please share any medical, physical, cognitive, or behavioral conditions which would be important for instructors to know
We encourage your camper to bring any sensory tools of their own that would help them have a positive camp experience. Please list those items above so camp staff is aware. Reid Park Zoo has sensory tools available for camper use, please call 837-8200 to learn more.
Zoo camp is fun and exciting, and can at times lead to heightened emotions. Please tell us how to best support or comfort your camper if needed
Please describe any restrictions of activity or diet
Primary Adult Contact's Name*
First Last
Relationship to Participant*
Primary Phone*
Secondary Phone
Is the Participant free of infectious disease, up to date on all immunizations required to attend school, and able to participate in recreation activities (with the limitations/restrictions listed above)?*
- Yes
- No
Is the participant taking medication?*
- Yes
- No
Name of medication(s)
Will medication(s) be taken during program hours?*
- Yes
- No
Medication Permit
The following information relates to your responsibilities if your child requires medication(s): 1.) For each medication required, a Medication Permit must be filled out and signed. Staff will not administer any medication that does not have a signed permit, including non-prescription medications. NO invasive medical procedures will be administered. 2.) All prescription medications must come in a pharmacy bottle with a legible pharmacy label on it. The label must contain the participant’s name, the pharmacy’s phone number, the name of the medication, dose and frequency required, and the doctor’s name. 3.) All non-prescription medications must be submitted in the original sealed container with the participant’s name, dose, and frequency clearly labeled on the container.
Name of Medication*
Dosage*
Name of Doctor Prescribing Medication*
Instructions for Giving Medication*
Possible Side Effects*
By initialing below, I hereby authorize Zoo Summer Camp Staff to give the above named medication to my child.*
Emergency Contacts
Contact's Name*
First Last
Please provide 2 emergency contacts
Relationship to Participant*
Primary Phone*
Secondary Phone
Contact's Name
First Last
Relationship to Participant
Primary Phone
Secondary Phone
Please list any other individuals who are authorized to pick up participant (individuals will be required to show a photo ID when picking the participant up). ONLY ADULTS LISTED BELOW, PRIMARY AND EMERGENCY CONTACTS WILL BE ABLE TO PICK UP YOUR CAMPER.
Permissions
I understand that 911 may be called in the case of a medical emergency*
- Yes I do
I hereby grant Reid Park Zoo permission to record the participant’s likeness and/or voice for use in television, social media, radio, or printed materials to further the aims of the Zoo in related campaigns and in other ways they may see fit.*
- Yes I do
- No I do not
By entering my initials below, I release and hold harmless the Reid Park Zoo, Reid Park Zoological Society, the City of Tucson, and employees or agents thereof, from any and all claims, liabilities, or demands whatsoever arising out of the enrollment or participation in any program by the participant herein.*
Relationship to Participant*
Date*
Date Format: MM slash DD slash YYYY

Reid Park Zoo Waiver Form

Health, Emergency Contact and Waiver of Liability Form- SUMMER

Health, Emergency Contact and Waiver of Liability Form - Summer Camp

Medication Permit

Emergency Contacts

Permissions