Camp Release Form

Please fill out the form below, or 2023 Camper Release form.docx in PDF.

Camper's Name*
First Last
Age of Child on First Day of Camp*
Dates Attending
In case of a request for the release of the camper to a person not listed below, the camper will remain with staff until you have been contacted and have given us permission to release him/her. Pick-up people need to bring a photo ID. To make additions to this list, the parent/guardian may send a signed note to camp. If there are specific people to whom your child may NOT be released, please inform the camp in writing - Give first and last names (i.e. John and Jane Smith, not “The Smiths”). Unscheduled late pick up (over 10 minutes from end of camp day) will be charged the Late Pick Up fee of $25.
My child may be released to the following people (include carpool drivers and those to pick up in an emergency
1st Parent / Guardian*
First Last
Relationship:*
Phone*
2nd Parent/Guardian
First Last
Relationship
Phone
Other Name
First Last
Relationship
Phone
Other Name
First Last
Relationship
Phone
Describe other possible means of dismissal (i.e. bike, walk, taxi, etc.)*
SPECIAL PICK UP ARRANGEMENTS (if needed)

I will need to make a special trip to the Dahlem Conservancy to pick up my child

Not Applicable
Date/Time
Reason

Contact Dahlem