Emergency Release Info

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EmergencyReleaseForm12.pdf
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Emergency Release Information

This information MUST be provided PRIOR TO START OF CAMP in order for your child to attend camp, and is necessary to insure the safety of the child while at camp.

If it is necessary for a child to leave camp early, THE CAMPER WILL ONLY BE RELEASED TO THE PARENT OR PERSON LISTED ON THIS RELEASE FORM. NO EXCEPTIONS (Please do not send older siblings or family members NOT listed on this form).

A parent MAY NOT call and say a neighbor is picking the child up.

IF THE PERSON PICKING UP THE CHILD IS NOT ON THE LIST, WE WILL NOT RELEASE THE CHILD, and ANYONE ASKING TO REMOVE A CHILD FROM CAMP EARLY IS REQUIRED TO SHOW VALID PROOF OF I.D..

REMEMBER TO SEND ANY CHANGES OR ADDITIONS PRIOR TO ASKING FOR EARLY RELEASE OF THE CAMPER.

* Indicates required field

Camp Location *

CAMPER 1 NAME *

First

Last

List Additional Campers here (First name and Last Name one per line) *

Authorized Pick-up Person 1 *

First

Last

Authorized Pick-up Person 1 Phone *

Relationship to Camper *

Authorized Pick-up Person 2 *

First

Last

Authorized Pick-up Person 2 Phone *

Auth. Pick-up Person 2 Relationship to Camper *

Please list any other persons authorized to pick you your child (Name, Phone, Relationship) *

Name of Parent/Legal Guardian signing this form *

First

Last

Date signed (MM/DD/YY) *

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