Camper Permissions 2026

Camper Permissions 2026

Please provide your consent by signing this form.
Please note: Any permission, such as having someone other than a parent pick up the camper at the end of a camp session, must be submitted in writing to the directors prior to pick-up day and must indicate the name and relationship of the person to the camper.
Person's Full Name

First NameLast Name
Is permitted to pick up
Camper's Full Name

First NameLast Name
On this Date

MonthDayYear
Date
Person's Full Name

First NameLast Name
Is NOT permitted to pick up
Camper's Full Name

First NameLast Name
White Water Rafting

Campers 12 years of age or older who attend Camp Pinehurst for 5 or 6 weeks are eligible to take the white water rafting trip. There is an additional charge for this trip. Prior to the trip, you will be sent a separate permission and release form from the rafting company requiring a signature.
Will you take the White Water Rafting trip?
I have read and discussed the Camp Policies with my camper, and my signature indicates agreement with the statements made above.
Parent/Guardian Signature
Should be Empty: