Pick up Release Form

(Please print.)

The following persons are authorized to pick up ___________________________ from Camp Rockfish.
(child's name)

 

Name (Please print.)

Address

Phone #

     
     
     
     
     

I understand that only those persons listed above will be authorized to pick up my child.

Signature:________________________________Date_________________

Name:________________________________________________________

(Please print)

Day Camp only- For every 15 minutes after 5:30 pm, ( 6:00 pm in the Summer) a late pick-up fee of $5.00 will be
charged per child.