Summer Camp Authorization Form and Photo Release 2025

Summer Camp Authorization Form
This form must be completed for your child to attend Summer Camp at Abington Art Center in 2025. This form must be filled out each year, even if your child has attended camp during previous summers.

Please submit this form BEFORE the first day of your child's camp.
Emergency Information
Student Name*

First NameLast Name
Student Date of Birth*

MonthDayYear
Date
Phone Number*

Area CodePhone Number
Pronouns
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Email*
example@example.com
Primary Phone Number*

Area CodePhone Number
Secondary Phone Number

Area CodePhone Number
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*

Area CodePhone Number
Is there anything you would like to share to help us make your child's experience better?
Does this camper have any allergies or medical conditions we should know about?*

YesNo
If you selected Yes, please specify and include a list of medications that your child is currently taking, or may need in case of an emergency.
I hereby authorize Abington Art Center and/or its representatives to take my child to the Emergency Room for emergency care in the unlikely event that we are unable to reach a parent, guardian, or emergency contact.*

AuthorizeDo Not Authorize
I hereby certify that I am the parent and/or guardian of the above minor(s) (an infant under the age of 21 years) and consent that any photographs which have been or are about to be taken by the staff and faculty, may be used by Abington Art Center for media, marketing, web, publications and other materials.

YesNo
Pick Up Authorization

If anyone other than the parent, guardian, or emergency contact is authorized to pick up your child from camp, please include their information below.
Name 1

First NameLast Name
Phone Number

Area CodePhone Number
Name 2

First NameLast Name
Phone Number

Area CodePhone Number
Does this student have permission to leave unaccompanied upon camp dismissal?*

YesNo
Should be Empty:

Summer Camp Authorization Form

Emergency Information

Pick Up Authorization