Application for Jr. Zoo Keeper Camp 09
Farm Located in Loris, SC off bypass Hwy. 9 and Liberty Church
Road
Camp 2010 dates coming soon.
Please email to check availability of dates.
Child’s Name _____________________________________________________ Age_________________________
Parent’s Name
____________________________________________(Mom) Cell #________________________Work
#_____________________
____________________________________________(Dad) Cell #_________________________Work
#_____________________
Home Address ________________________________________________
________________________________________________
Home Phone # __________________________________
Emergency Contact Person Name_________________________________________
Phone #____________________________
Medical Information you feel we need to know____________________________________________________________________
_________________________________________________________________________________________________________
Medicines: Any medications that must be taken during camp hours, should be detailed in writing on Monday to camp
leader.
Who will be picking up your child? _____________________________________________________________________________
If this person is unable to pick up, please provide a note.
Waiver: I understand that while reasonable efforts of 5 Star Farm and Zoozort will be taken to ensure participants’
safety, campers participate at their own risk. 5 Star Farm or Zoozort and it’s representatives are not responsible in
the event of accident or injury. I will instruct my child to conduct him or her self accordingly and to follow all instructions
given to them. If my child is doesn’t comply with rules I will be contacted and my child will be picked up within the
hour. I agree to allow 5 Star Farm and Zoozort to obtain photos or video of the event for promotional materials.
_____________________________________________________________________________________
Parents
Signature Date
_________________________________________
Print Name
Fill out application, send full payment with Check payable to 5 Star Farm to
5 Star Farm
1410 Edge Drive
North Myrtle Beach, SC 29582
Space
is limited to 25children a day, first come first served. If we receive your application after the week is
full, we will notify you about possibly alternate date for camp or return monies to you. All payments due week before camp
date. Discounts for earlier registration.
Helpful Information
Ages: 7 through 13 Hours: 9:00am
to 3:00pm Cost: $250.00 for week (5 days) or $65.00 a day
We ask that children DO NOT wear good clothes and bring a change (in case they get wet
or dirty)
Bring a bag lunch (&drink), a notebook or journal & pencil
DO NOT wear open toed shoes
For more information
Email sc5starfarm@aol.com or zoozort@gmail.com
