2. 

3. Vernon Township Summer Camp Carpool List 2023

5. Camper's Name*
6. Camper's Age Group*
8. In the space provided below please include ANYONE (including grandparents, relatives, step-parents, partners, neighbors, friends, etc.) who is permitted to pick up your child from camp.
10. If during the camp year you would like to add a person to this list, a note must be written and signed by a parent. We will not accept phone calls or e-mails about issues during the camp day. “This is my written permission for my child/ward to leave camp with the following individuals:”
12. Parent/Guardian 1
13. Parent/Guardian 2
15. 1.
16. 2.
17. 3.
18. 4.
20. 5.
21. 6.
22. 7.
23. 8.
25. 9.
26. 10.
27. 11.
28. 12.
30. 13.
31. 14.
32. 15.
33. 16.
35. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
37. Electronic Signature*
Leave This Blank:


39. 1. Receive an email copy of this form.
40. Email address

    This field is not part of the form submission.

41. Submit

* indicates a required field