PARENT/GUARDIAN CONSENT FORM

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**THIS FORM MUST BE COMPLETED AND SUBMITTED PRIOR TO THE FIRST DAY OF ATTENDANCE.**

First & Last name of Child *

First & Last name of Guardian

I will be picking up my child(ren) from camp. *

Yes

Required

Someone other than myself is picking up my child(ren) at camp. *

Yes

NOTE: Each camper will NOT be released to anyone other than the parent or legal guardian without this signature. If car-pooling, please list all potential drivers. *

I, the undersigned, hereby grant permission for the following people to pick up my child(ren) at the conclusion of the Rhythm Dribble Summer Program each day. Name of adult picking child(ren) up: *

CONSENT SIGNATURE: I understand that the Camp Director reserves the right to dismiss any camper exhibiting behavior detrimental to the goals of the camp or that infringes on the rights of other campers to enjoy a safe and orderly environment, and in the event of this unfortunate circumstance, the tuition of the dismissed camper will not be refunded. I understand all pictures, video and other media taken at camp is the exclusive property of Rhythm Dribble, or our designee, and may be used at our discretion.

CLICKING SUBMIT IS EQUIVALENT TO YOUR SIGNATURE.

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