Camper Pick-up Authorization Form

Dear Camper Parent/Guardian,

Caz will not release your camper to anyone other than a parent/guardian unless we have your signed authorization. If you would like to authorize another person (ie. brother, grandparent, family friend) to take your camper off-site then please complete this form.

Note: If a designated parent/guardian will pick up your camper, you do not need to fill out this form.

Camper First Name

Camper Last Name

Session Attending

Parent/Guardian Email:

Parent/Guardian Name

Phone

Parent/Guardian Name

Phone

Please name the adult(s) whom you are authorizing to pick up this camper:

First and Last Name

Relationship to camper

Phone

best number to reach individual

Alternate Phone

Optional

Acknowledgement

Parent/guardian signature

Date

I understand that typing my name above constitutes a legal signature.

Contact Information