Consent Form for Licensed Camps

Consent Form for Licensed Camps

Use this online form to submit all the emergency and safety info for your child for our Licensed Camps such as Champ Camp, PAL Camp and school break programs. You can also download a PDF version to print and deliver.

Licensed Day Camp Registration

  • GENERAL INFO

  • BACKGROUND INFORMATION

  • EMERGENCY CONTACT INFORMATION

    Two contacts OTHER THAN PARENTS/GUARDIANS are required for our childcare license.

  • MEDICAL EMERGENCY INFORMATION

    If yes, please complete the Medication Form below. This must be filled out to dispense medication during camp.

  • PICK UP INFORMATION

  • PERMISSION FORM

    Occasionally, an activity may include showing a movie. Licensing regulations require permission from parents for students to view a PG movie.
    Please check the box to indicate your understanding

  • Form Submission

    By submitting this form electronically, you agree that you have read, understood and provided accurate information.
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Authorization to Give Medication

  • MM slash DD slash YYYY
  • MM slash DD slash YYYY

  • Prescriber’s Information

  • Permission to Give Medicine

    I hereby give permission for the camp program to administer medicine as prescribed above: I also give permission for the caregiver/teacher to contact the prescribing health professional about the administration of this medicine. I have administered at least one dose of medicine to my child without adverse effects.

    * Please note that medication cannot be administered until the above information is filled out