Special Saturdays Registration Form
As part of our ongoing partnership with KultureCity to provide inclusive opportunities to all members of the community, the Education Department at the Birmingham Zoo excited to announce our new Special Saturdays program. Special Saturdays is a series of zoo-based learning experiences for children and adolescents with cognitive or physical disabilities whose opportunities for engagement in community programs might otherwise be limited. Caregivers must attend all classes with participants to provide behavioral support and meet child-specific needs. In collaboration with KultureCity, this program is designed with the unique learning needs of this population in mind. Using evidence-based teaching and sensory strategies, we hope to provide a fun and engaging educational experience that will benefit all participants.

Classes are held the second Saturday of each month:

May 13 August 12
June 10 September 12
July 8 October 14

Ages/Times:

13 — 18 year old classes are held from 10:00 AM — 11:30 AM
8 — 12 year old classes are held from 1:30 PM — 3:00 PM

There is no charge for the Special Saturdays program. Space is limited to 10 students per class. Caregivers must attend all classes with participants to provide behavioral support and meet child-specific needs. Priority is given to families who can commit to attend all 6 classes.

Student's Name
Your answer
Grade
Your answer
School System
Your answer
Age
Your answer
Gender
Your answer
Birthdate
MM
/
DD
/
YYYY
Medical conditions/diagnosis:
Your answer
Allergies:
Your answer
Mobility (please check all that apply)
Communication (please check all that apply)
Does your child have sensory processing difficulties? If yes, please describe and list any strategies in place.
Your answer
Does your child have behavioral difficulties? If yes, please describe and list any management techniques, if any, and frequency of behavior.
Your answer
Is there additional information about your child that you would like to provide in order to assist us in providing an inclusive learning experience for them?
Your answer
Parent/Guardian's Name
Your answer
Address
Your answer
Home Phone
Your answer
Cell Phone
Your answer
Email Address
Your answer
Birmingham Zoo Member?
Has your child visited the Birmingham Zoo before?
Can you commit to attend monthly classes on the following dates:
How did you learn about the Birmingham Zoo's Special Saturdays Program?
Your answer
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