Departure Release Form

This form needs to be filled out ONLY if the parent or legal guardian is NOT picking up his or her own child at the end of the session.

Camper Info

* Which Camp?

* Camper Full Name

* Parent/Guardian 1 First Name

* Parent/Guardian 1 Last Name

* Parent/Guardian 1 Email

Parent/Guardian 2 First Name

Parent/Guardian 2 Last Name

* Individual 1 First Name

* Individual 1 Last Name

Individual 2 First Name

Individual 2 Last Name

* Relationship To Camper

* Expected Date of Camp Departure

If this is a change from previous travel plans that were communicated to Camp, please explain:

* Parent/Guardian Signature