nd Scholarship Information Miami, Florida 33177

Zoofari Summer Camp 2014 Zoological Society of Florida
Scholarship Information
12400 SW 152nd Street
Miami, Florida 33177
(305) 255-5551
www.zoomiami.org

Tuition assistance:

The Zoological Society of Florida offers tuition assistance for children to attend Zoofari Camp at Zoo Miami.
Scholarships for Zoofari Summer Camp 2014 are awarded on a competitive basis of financial need and
interest in the environmental field. Families must be Florida residents and are responsible for transportation
to and from the Zoo.

Scholarship recipients are entitled to full tuition for one or two weeks (ages 4-10) and
one week (ages 11-13) of summer camp based on availability, with optional extended care included.

You may apply for (1-2 weeks), Monday–Friday of the following camp weekly sessions:

June 16-20 June 23-27 July 14-18

Ages 4-10 Ages 4-10 Ages 4-10 and 11-13

Scholarships are awarded once each year based on financial need, motivation, and desire to
positively affect the environment and the lives of animals.
Applications MUST BE EMAILED OR POSTMARKED by Thursday, May 15, 2014.
You will be notified by email or mail after May 28 if you have received an award or not. Please do
not email or phone about the status of your application.

How to apply for a scholarship:
Scholarship application MUST BE EMAILED OR POSTMARKED by May 15, 2014.

Please note: Incomplete, late, or faxed applications will not be reviewed.

The scholarship application is divided into 2 parts as follows:
Part 1: Application Form with financial information and description on how the camper benefits
from attending Zoofari Camp
Part 2: Camper Registration and Medical Form

Please make sure you have both parts and fill them out appropriately and completely. Be sure to indicate
the week(s) of camp you are applying for on the camper’s registration form. All applications are kept
confidential.

Email completed Application Form, Camper Registration and Medical Forms to: [email protected] with
Scholarship in the subject line.
Mail completed Application Form, Camper Registration and Medical Forms to:

Summer Camp Scholarships
Zoological Society of Florida at Zoo Miami
12400 SW 152nd Street
Miami, Florida 33177-1499

Scholarship Application Education Department Zoological Society of Florida

Zoofari Summer Camp 2014
Scholarship Application

1) Camper’s Name: _________________________________  Male  Female

Birth Date: ____________ Age: _______ Week: June 16 June 23 July 14

2) Camper’s Name: _________________________________  Male  Female

Birth Date: ____________ Age: _______ Week: June 16 June 23 July 14

Describe how the camper(s) would benefit from camp:

Scholarship recipients will be asked to write a note or draw a picture of appreciation for our scholarship
fund donors. These notes are cherished by our supporting donors and let them know of the difference their

donations make in the lives of young children. Names will be kept confidential if requested.

Scholarship Application Education Department Zoological Society of Florida

Zoofari Summer Camp 2014
Scholarship Information

Parent/Guardian Information

Head of household: __________________________________________________________
First and last name

Street Address, City, Zip code: _________________________________________________

Home Phone: _________________ Work Phone: _______________Other:______________

Marital Status (circle one): single married divorced separated

Spouse Name: _____________________________________________________________

Total family size: ___________ # of adults: ____________ # of children: _____________

Income and Employment Information

Head of Household: ________________________ Spouse: _________________________________

Employer’s Name: _________________________ Employer’s Name: _________________________

Address: ________________________________ Address: _________________________________

Phone Number: ___________________________ Phone Number: ___________________________

Gross Annual Income 2013: ______________ Gross Annual Income 2013: ___________

Total Gross Annual Household Income: ____________________________

Does the applicant receive or does he/she qualify for free/reduced meals at school?

 Yes  No

Please submit the documents as specified below and indicate the type of documentation attached to
this application:

A photocopy of the prior year income tax return (1040) with the attached W-2 form

AND

One of the following:

Two (2) most recent pay stubs/checks for each employer listed above OR:
Proof of unemployment benefits, Social Security Income, Supplemental Security Income, Medicaid
Card, and/or Food Stamps

Scholarship Application Education Department Zoological Society of Florida

Zoofari Summer Camp 2014
Scholarship Information

What else, if anything, would you like the Scholarship Awards Committee to know?

I hereby attest that to the best of our knowledge, the information
provided on this form is true, complete and accurately reflects the income of all
persons living in our household. I further hereby give approval to the ZSF to
contact the employers listed for verification purposes.

The ZSF reserves the right to require additional documentation when deemed appropriate. This
application is valid for the current calendar year.

I realize that scholarships are subject to funds available and that awards will be made in an equitable
fashion at the discretion of the Zoological Society of Florida’s Scholarship Awards Committee.

____________________________________________________________________

Parent’s/Guardian’s Signature Date

____________________________________________________________________
Parent’s/Guardian’s Name (Please print)

All information will be kept confidential.

Scholarship Application Education Department Zoological Society of Florida

Office use only: ZOOFARI SUMME
dte:_______
db:________ SCHOLAR
cfo:________

Please print clearly Weeks of June 16; J

CAMPER’S

FIRST NAME: ______________________________LAST: _______________

Birth date_________________ Age________ M__ F__ Grade (in Fall 2014) _____

Address: _________________________________City: __________Zip:_
T-Shirt size: Child S___ M___ L___ Adult S___ M ___ L ___
Email address (print clearly): _____________________________________

Name(s)-PARENT/GUARDIAN: EMERGENCY & PICKUP (2 only) Day & Em

First _________________ Last ___________________ ___________
First _________________ Last ___________________ ___________

Name(s)-Additional Authorized Persons: Pickup only (2)

First _________________ Last _________________________

First _________________ Last _________________________

CHILD’S MEDICAL INFORMATION

Allergies: NO____ YES ____

Medical / other conditions: NO____ YES ____

Medications: NO____ YES ____

The Medical Form must be filled out and submitted with this Registration Form.
If Medications need to be dispensed by ZSF Staff, the additional Authorization
Form is required.

WAIVER: I (print name) ______________________________, parent/legal guardia
of Florida (ZSF) camp program. Neither the ZSF or Zoo Miami (ZM), Miami-Dade C
to any person or property arising out of the use of ZM facilities during this program.
ZM, MDC or its employees arising from the child’s participation in this program and
supplied accurate information and I can be reached at the numbers listed above. I
Signature of Parent/ Guardian: ________________________________________
Photo policy: Visitors to Zoo Miami may be photographed or videotaped during the

purposes without compensation.

_________________________________

ER CAMP 2014

RSHIP
June 23; July 14

________ Ages 4-10 yrs available weeks:

___ Check week(s) camper will attend (Limit of two)

_______ Camp Extended Camper’s

_____________ Week Care Age

mergency Phone # June 16-20 _______ ________ _____ years

____________ June 23-27 _______ ________ ______ years
____________
July 14-18 _______ ________ ______ years

Age 11-13 yrs available week:

Camp Extended Camper’s

Week Care Age

July 14-18 _______ ______ _____ years

Financial Aid Acceptance Date: ________________

Signature: _____________________________________

(Parent/Guardian)

SUBMIT FORM BY:

E-MAIL: [email protected];
with Scholarship in subject line

MAIL: Summer Camp Scholarship
Zoological Society of Florida, Zoo Camp,
12400 SW 152 Street, Miami, FL 33177

We do not accept phone inquiries on scholarships.

an of the camper give permission for my child to participate in the Zoological Society
County (MDC) or their employees will be liable for any camper for injury or damage

All participants and chaperones agree to waive any and all claims against the ZSF,
presence at Zoo Miami. I have read the registration and medical sections and have
authorize ZSF to transport and/or obtain medical services for my child if necessary.
______ Date: _________
eir visit. Their likeness may be used for marketing, advertising or public relations

All programs are subject to change

Zoo Miami
ZOOFARI CAMP
2014 Scholarship

Medical Form

MEDICAL INFORMATION

Child’s name: _______________________________Age_______
Physician’s name: _______________________________________
Phone: ________________________________________________
Allergies: ______________________________________________
______________________________________________________
______________________________________________________
Health condition(s):______________________________________
______________________________________________________
______________________________________________________
______________________________________________________
Medications: ___________________________________________
______________________________________________________
______________________________________________________

Submit this form with the 1st registration page.
Use additional Authorization to Dispense Medication(s) if needed.

Summer Scholarship, Zoological Society of Florida
12400 SW 152nd Street, Miami, Florida 33177

Zoological Society of Florida

Zoo Miami

ZOOFARI CAMP

2014 Scholarship

Authorization to Dispense Medication

MEDICAL INFORMATION

Child’s name: _________________________________Age______
Health condition(s):_______________________________________
_______________________________________________________
_______________________________________________________
Physician’s name: ________________________________________
Phone: _________________________________________________
Physician’s address: ______________________________________
City/Zip Code: ___________________________________________
Medication: _____________________________________________
Dosage: ________________________________________________
When medication must be administered: ______________________
_______________________________________________________
Directions on how to administer medication: ___________________
_______________________________________________________
_______________________________________________________

Submit this form with the 1st page if you answered YES on the
Campers Medical Information section of the Registration Form

Summer Scholarship, Zoological Society of Florida
12400 SW 152nd Street, Miami, Florida 33177

Zoological Society of Florida