Summer Camp Authorization Form and Photo Release 2026

Summer Camp Authorization Form
This form must be completed for your child to attend Summer Camp at Abington Art Center in 2026. This form must be filled out each year, even if your child has attended camp during previous summers.

Please fill out this form ASAP!
Emergency Information
Student Name

First NameLast Name
Student Date of Birth

MonthDayYear
Date
Phone Number

Area CodePhone Number
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
Does this camper have any allergies or medical conditions we should know about?
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. Please note that AAC staff will reach out if we are unable to properly care for your child.
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.
Behavior Policy: Campers will treat all other campers, teachers, interns, Art Center staff, artworks and the property/grounds with respect. Verbal and physical abuse, including foul or obscene language and gestures, as well as disregard for physical safety will result in expulsion from camp without a refund or credit.
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.
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?(age 13 and up only)
Should be Empty:

Summer Camp Authorization Form

Emergency Information

Pick Up Authorization