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Authorization Release Form
I hereby give permission for the Town of Guilderland Parks & Recreation Department, Tawasentha Day Camp program to release my child to, and only to, the following:
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* Indicates required question
Campers Last Name:
*
Your answer
Campers First Name:
*
Your answer
Campers Group (Grade entering in the fall of 2022)
*
K-1
2-3
4-5
Middle School
JVC
Other:
Provide Full Name of Primary Pick-up Person:
*
Your answer
Provide Phone Number of Primary Pick-up Person:
*
Your answer
Provide Full Name of Emergency Pick-up Person:
*
Your answer
Provide Phone Number of Emergency Pick-up Person:
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Your answer
Provide Alternate Pick-up Contact Information, if applicable:
Your answer
Please provide any additional pick-up or drop-off information our staff should be aware of?
*
Your answer
Check all the Weeks that apply:
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Week 1 - June 27th - July st
Week 2 - July 5th - July 8th
Week 3 - July 11th - July 15th
Week 4 - July 18th - July 22nd
Week 5 - July 25th - July 29th
Week 6 - August 1st - August 5th
Required
Signature of Parent/Guardian & Date:
*
Your answer
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