Parental Authorization Form

Parental Authorization Form

Please complete the form before the 1 day of camp.
Campers Full Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Parent/Guardian Name(s)

First NameLast Name
First NameLast Name
Phone Number: Parent/Guardian 1
Please enter a valid phone number.Format: (000) 000-0000.
Phone Number: Parent/Guardian 2
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact (If parent/guardian cannot be reached)

First NameLast Name
Phone Number: Emergency Contact
Please enter a valid phone number.Format: (000) 000-0000.
Authorization for First Aid and Emergency Medical Care

I hereby give permission for the staff of Just Claying Around Summer Art Camp to administer basic first aid to my child. In the event of a medical emergency, I authorize camp staff to contact emergency medical services and allow medical professionals to provide care as necessary, including transport to a medical facility.
Authorization to Administer Emergency Medication (if applicable)

I authorize camp staff to administer the following emergency medication(s) to my child in the event of a medical emergency (e.g., allergic reaction). All medications must be provided by me in original packaging with my child’s name clearly labeled.
List of Medication(s):
Date of Authorization

MonthDayYear
Date
Signature of Parent
Printed Name

First NameLast Name
Should be Empty: