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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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Campers Last Name: *
Campers First Name: *
Campers Group (Grade entering in the fall of 2022) *
Provide Full Name of Primary Pick-up Person: *
Provide Phone Number of Primary Pick-up Person: *
Provide Full Name of Emergency Pick-up Person: *
Provide Phone Number of Emergency Pick-up Person: *
Provide Alternate Pick-up Contact Information, if applicable:
Please provide any additional pick-up or drop-off information our staff should be aware of? *
Check all the Weeks that apply: *
Required
Signature of Parent/Guardian & Date: *
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