• Camper Information

  •  - -
    Pick a Date

  • PARENT/GUARDIAN INFORMATION

  • EMERGENCY CONTACT (other than a parent/guardian)

  • Authorized pick up form

    Please list ALL persons authorized to pick up the child or to notify in case of emergency. Make sure to list yourself and any parents also listed above. No one will be allowed to pick up the child unless they are on this form. Photo ID will be required at the time of pick up (we make no apologies for safeguarding your child). Children must be signed out by the person picking up the child. Thank you for your cooperation.

  • Waiver of Participation

  • I/We the below signed person/parent(s) having legal custody/legal guardianship of said minor, give permission for said minor to attend any Derby Recreation Commission (DRC) activities supervised by authorized DRC staff.  Said minor is physically able and mentally prepared to participate in all activities.

    I/We do hereby authorize the DRC and DRC staff to transport said minor in DRC bus, van, car or other vehicle to/from the site for daily transportation and/or field trips, emergency care, etc.

    I/We have read the Parent Handbook and understand all policies and procedures set forth by the DRC.  I/We shall abide by said policies/procedures and will review these with my/our child.  I/We support the DRC in its enforcement of these policies/procedures.

    I/We have read and understand the DRC’s policies concerning discipline and will pass this information along to my/our child.  I/We understand that the DRC reserves the right to dismiss any child who fails to adhere to DRC Recreation Station rules and regulations.

    I/We understand fully and will abide by the DRC’s policy concerning drop-off and pick-up of children.  I/We shall be prepared DAILY to present photo ID to on-site staff to determine my/our identity as authorized persons to pick up my/our child.  Further, I/We shall inform others who are authorized to call for our child to present photo ID when picking up my/our child.

    In consideration of the DRC accepting this entry, I/We hereby for myself, my/our child, my heirs, executors and administrators, waiver and release any and all rights and claims for damages my/our child may have against the Derby Recreation Commission, City of Derby, or USD No. 260, and its representatives, successors and assigns for any and all injuries suffered by my child at any activities sponsored by these groups.  Parent or Legal Guardian must sign for any child under 18 entering the program.

     

  • Clear

  • Late Fee Policy

  • Discipline Policy

  • Bus Rules

  • Dress Code Policy

  • High Risk Activity Waiver

  • Clear

  • Parental Permission Form for Off-Premise Trips

  •    *   *   may go to the following locations off the premises with adult supervision.   *   

  • Clear
  • Should be Empty: