Camp Permission Form

May the child go home with either parent? YesNo If not, to whom may the camper be released?
List one other adult to whom the student may be released/who may be contacted in case of emergency:
Emergency Contact's Name Phone Number
NOTE: If someone comes to pick up your child and they are not listed here, we will not release the child to them unless the child has a note from you. If your child needs to be released early from camp, please send a note with your child to give to the teacher listing the time, date, and the person who will be picking the child up.


In return for acceptance of my child’s registration for this camp, I, for myself, my executor, administrators and assigns, hereby release and discharge the Delaware County Cultural Arts Center (The Arts Castle), any and all sponsors or teachers associated with the program, their agents and employees, independent contractors, volunteers, board members, and sponsors from liability for any and all claims for damages, actions, demands, and injuries arising out of any participation in this camp, whether that arise at The Arts Castle or off the grounds while participating in the program. I have full knowledge of all risks involved in my child’s participation in the camp. I also release and discharge the Delaware County Cultural Arts Center (The Arts Castle) for any and all claims for damages, actions, demands, and injuries arising out of travel between The Arts Castle and any off-site class work or performances, regardless of the means of transportation or the person or persons providing the transportation.

Lastly, I give permission for my child to accompany The Arts Castle summer camp program on walking field trips in the immediate area of The Arts Castle during the time he/she is at camp


I give you permission.I do not give you permission
In return for acceptance of my child’s, I hereby grant and give this organization and its partner organizations the right to use my/my child’s photograph and/or video image with or without my/my child’s name, both singly and in conjunction with other persons or objects, for any and all purposes including, but not limited to, private or public presentations, advertising, publicity, and promotion.


So that we can better assist your child and also in case of emergency, please list your child’s allergies, dietary restrictions, medical conditions, medications being taken, physical impairments, and/or special needs, if any:
Are there any medications your child needs to take while at camp?
If yes, please list the medication(s), dosage(s), and the time(s) of administration below.
FOR EPI-PENS, INSULIN KITS, & INHALERS: If students typically keep these medications with them at school, then students may keep these medications with them at camp.

FOR ANY OTHER MEDICATIONS: Please put the medication in its original packaging in a Ziploc bag with the student’s name, medication name, dosage, and time of administration clearly marked on the bag, and turn it in to the Arts Castle instructor on the first day of camp. Students will administer their own medication.
Please list any allergies:

Additional Notes: