Summer Camp Student Checkout Authorization

Summer Camp Student Check-Out Authorization

I understand that Pineywoods encourages campers to experience the entire camp session with their group, beginning to end. However, circumstances necessitate my son/daughter leaving camp when specified below, rather than him/her participating in all scheduled camp sessions/activities or traveling from camp with his/her church group.

Name of Student

First

Last

Church Name & City

Check-Out Details

Check-out day, date, time, etc.

Adult Authorized to Pick Up Student

He/She must be 21 years of age or older.
Boyfriends/girlfriends (no matter their age) are not permitted to pick up any student.

Name of Authorized Adult

First

Last

Relationship to Student

Driver License State of Issue and Number

NOTE: The authorized adult must present his/her driver license before student will be released.

Liability

I understand that once my child leaves the Pineywoods campus with the adult I have authorized to pick him/her up, I assume all liability for his/her safety. I also understand that Pineywoods Camp will not allow anyone under 21 years of age to pick up my child.

Electronic Signature

I understand and agree that by typing my name below, I am providing my electronic signature, which is the legal equivalent of my manual/handwritten signature on this document.

Signer Name

First

Last

Signer Relationship to Student

Signer Mobile Phone Number

Signer Email Address

Name

Summer Camp Student Check-Out Authorization

Adult Authorized to Pick Up Student

address & phone

OFFICE hours & COORDINATES