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Camper Release Form

Please complete one form per camper per camp. The preferred phone number will be the first one we use if we need to contact you for any reason.


Child’s name: *   
Age: *   
Parent/Guardian name: *   
Email: *  
Preferred Phone: *   
Add’l Phone:   
Name of camp: *   
Start Date of Camp: *  
Are there legal custodial issues that we should be aware of? *
 Yes

 No

 
If yes please explain:
If anyone other than the person listed above is authorized to pick up your child, please list their name(s) and phone number(s) below. That number must be where that person may be reached during camp hours. Please be sure to list the alternate emergency contact and the parents of any other campers if you plan to carpool. ID will be required upon pick-up.
Name/Relation:   
Phone:   
Cell:   
Name/Relation:   
Phone:   
Cell:   
Name/Relation:   
Phone:   
Cell:   
Did you order a summer camp t-shirt? *
 Yes

 No

 
If yes please specify the number of shirts purchased:   
Please specify the size of each shirt:
 XS (2-4)

 S (6-8)

 M (10-12)

 L (14-16)

 XL (18-20)

 All sizes are Youth sizes.
If no and you would like to order please specify the number of shirts you would like to purchase:   
Please specify the size of each shirt:
 XS (2-4)

 S (6-8)

 M (10-12)

 L (14-16)

 XL (18-20)

 All sizes are Youth sizes.