Animal Care Academy Application Salisbury ZooAnimal Care Academy Application Animal Care Academy How many children would you like to register?(Required)123Child InformationChild Name(Required) First Last Birthdate(Required)mm/dd/yyyyNick Name/Preferred NameAge(Required) 13 14 15 16 17 Gender(Required) Female Male Non-Binary Prefer Not to Say Contact Phone #(Required)Contact Email Address(Required) Email Address Confirm Email Address What Adult Size T-Shirt are You?(Required)SmallMediumLargeX-LargeAdult Unisex ShirtsWhat is your favorite animal at the zoo?(Required)Medical Information DisclosureAllergies, Medications that need to be taken at Camp, any disabilities to disclose Any Animal Phobias? If so, what?spiders, snakes, birds, etc. Child Information #2Child Name(Required) First Last Birthdate(Required)mm/dd/yyyyNick Name/Preferred NameAge(Required) 13 14 15 16 17 Gender(Required) Female Male Non-Binary Prefer Not to Say Contact Phone #(Required)Contact Email Address(Required) Email Address Confirm Email Address What Adult Size T-Shirt are You?(Required)SmallMediumLargeX-LargeAdult Unisex ShirtsWhat is your favorite animal at the zoo?(Required)Medical Information DisclosureAllergies, Medications that need to be taken at Camp, any disabilities to disclose Any Animal Phobias? If so, what?spiders, snakes, birds, etc. Child Information #3Child Name(Required) First Last Birthdate(Required)mm/dd/yyyyNick Name/Preferred NameAge(Required) 13 14 15 16 17 Gender(Required) Female Male Non-Binary Prefer Not to Say Contact Phone #(Required)Contact Email Address(Required) Email Address Confirm Email Address What Adult Size T-Shirt are You?(Required)SmallMediumLargeX-LargeAdult Unisex ShirtsWhat is your favorite animal at the zoo?(Required)Medical Information DisclosureAllergies, Medications that need to be taken at Camp, any disabilities to disclose Any Animal Phobias? If so, what?spiders, snakes, birds, etc. Guardian InformationParent/Guardian Name(Required) First Last Cell Phone(Required)Home PhoneWork PhoneYour Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Emergency Contact(Required) First Last Cell Phone(Required)2nd Emergency Contact First Last Cell PhoneAuthorized Pick-UpAuthorized Pick-Up Person #1(Required) First Last Parent/Guardian listed prior will be listed as an authorized pick-up automatically. Relationship(Required)Relationship to CamperContact Phone #(Required)Authorized Pick-Up Person #2 First Last RelationshipRelationship to CamperAuthorized Pick-Up Person #3 First Last RelationshipRelationship to CamperAuthorized Pick-Up Person #4 First Last RelationshipRelationship to CamperContact Phone #Consent(Required) I agree to abide by all zoo policies and procedures.Product Name Quantity(Required) Price: $250.00 Quantity Total Credit Card(Required) Cardholder Name Card Details
