Patient and Family Form
Names & Attendees
Please note: each Creature Connection visit is limited to six people. The number is limited to six so that we do not overwhelm the zoo animals and also due to limited space available in some of the behind the scenes locations.
Patient: First Name + Age:
Sibling(s): First Name + Age
If applicable, not required
Adult(s): First Name
A minimum of one adult must accompany the patient.
We will only use this cell number if our staff have trouble finding you on the day of your Creature Connection visit.
Please check all that apply:
It is okay to text this phone number relating to the Creature Connection visit.
It is okay to call this phone number relating to the Creature Connection visit.
Car + Meet up location
A Pets for Patient staff member meets each patient/family in the main circle at Cincinnati Children's Hospital Medical Center (3333 Burnett Ave) at 3:45pm on the day of the visit. The family will then follow the Pets for Patients staff member in their own car to the Education Center at the Cincinnati Zoo. We do this since many families are unfamiliar with the location and entrance for the Education Center.
Car - Make, Model, Color.
We need your make, model and color of the car your family will be driving so our staff can easily find you at the main circle at CCHMC.
Please check all that apply. Please use the other box to elaborate on any specific needs or accommodations you might need. It is important to us that we tailor this visit to the needs of the patient and family.
Wheelchair accessible spaces
We will need a wheelchair provided by the zoo
Aversion to loud noises and/or sensory needs
Other factors/accommodations that would be helpful for the staff of Pets for Patients and the Cincinnati Zoo to know:
The purpose of Creature Connection is to provide a patient and their family with a unique, once in a lifetime behind the scenes encounters with animals at the Cincinnati Zoo. It is important to us that we take into account preferences of the patient and family when considering animals.
The Cincinnati Zoo gives animals a choice to participate in an encounter or not. We will do our best to accommodate preferences but cannot guarantee any particular animal will be accessible for a behind the scenes encounter.
Zoo Animals we would LOVE to meet:
Please check all the apply. If you have an absolute favorite please specify in the "other" box.
Cockroaches and other bugs
Zoo Animals we would NOT like to meet:
Please check all the apply. If animals you are afraid of or would not like to meet are not listed, please specify in the "other" box.
No restrictions or fears of animals - any are fine!
Cockroaches and other bugs
Rules for Behind the Scenes Tours
Please check ALL to show you have read the rules of the behind the scenes tour
We understand that animals can be unpredictable. We will follow the instructions of the zoo employee that is leading our behind the scenes tour.
When given permission to touch an animal, we must follow the explicit instructions from the zoo employee and be very gentle with touches.
We understand that photography behind the scenes is limited only to the animal(s) being shown on the tour. All photos must be cleared by a zoo employee.
Cell phones must be on silent during the encounter to not frighten or scare the animals.
After your behind the scenes visit
Patients and their family are welcome to stay at the zoo until it is open and explore all of the animals in exhibit for the public after the behind the scenes visit is complete. Please note, zoo hours change seasonally. Go to the Cincinnati Zoo and Botanical Gardens website for more information:
We are looking forward to seeing you at your Creature Connection visit!
Creature Connection is brought to you by the Cincinnati Zoo, Pets for Patients, and Cincinnati Children's Hospital Medical Center.
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