Walking/Biking Camp Permission Form

RELEASE FOR WALKING/BIKING TO AND FROM SUMMER CAMP
This form is the approval that my child may walk/bike to or from camp unaccompanied by a parent, guardian, or authorized representative of a parent/guardian. All information must be completed below.
Participant Name*

First NameLast Name
Program Name*
Activity Code*
Ex: 2202010
Dates*
Enter the start and end date for the program.
Location*
For your child’s safety, all parents whose camper(s) will be arriving at or leaving from Camp unaccompanied by a parent, guardian or authorized representative of a parent/guardian must sign this waiver. Campers is responsible to sign themselves in upon arrival and departure from camp.
- Campers may only arrive and depart during allotted times.
  - Arrival, 8:00-9:00a
  - Departure, 3:00-5:00p
- Please be as specific as possible on times arriving and departing.
Prior to their signing into Camp and after their signing out of Camp, my child will not be supervised by the Camp staff and shall not be considered a participant in the program.

I understand that the Huntley Park District is not responsible, for my child on the way to or from Camp, including, but not limited to, circumstances in which I have authorized the Park District to release my child without accompaniment. The Huntley Park District is not responsible for personal property and/or lost or stolen equipment, which includes (but is not limited to) bikes, roller blades, and any other personal property of Campers that they may use to get to/from Camp.
Check the box and enter the time that applies to your child below:

My Camper will arrive by walking or biking to campMy Camper will depart by walking or biking from camp
What time will your camper arrive at camp in the morning?*

Hour : Minutes Minutes

AM/PM Option
What time will your camper depart from camp in the afternoon?*

Hour : Minutes Minutes

AM/PM Option
Parent Name*

First NameLast Name
Parent Email*
example@example.com
Parent Signature*

Clear
Date

MonthDayYear
Date
Should be Empty:

RELEASE FOR WALKING/BIKING TO AND FROM SUMMER CAMP