Summer Zoo Camp 2021 Immunization Form Question Title * 1. Please complete the below information. One form per camper. Parent/Guardian Last Name: Parent/Guardian First Name: Camper Last Name: Camper First Name: Question Title * 2. Week of Camp: Date and Type of Camp (Summer Zoo Camp, Middle School Camp, High School Camp, Camp No Limits, or Summer Camp Overnight) Question Title * 3. Campers Age 3 years old 4 years old 5 years old 6 years old 7 years old 8 years old 9 years old 10 years old 11 years old 12 years old 13 years old 14 years old 15 years old 16 years old 17 years old 18 years old Question Title * 4. IMMUNIZATION CONFIRMATION I confirm that this camper is current with all necessary immunizations required by TDSHS, the county public health office, and local school district. Camper does not receive immunizations for religious/medical reasons. Question Title * 5. Camper has received the following immunizations: (Please check all that apply). Tetanus Booster Tuberculin (TB) MMR DPT Question Title * 6. Family Doctor: (Name and phone number). SUBMIT!