Permission Form for Summer Camp 2008
Location: BA Gary Gymnasium
Start Date: June 9, 2008
End Date: August 8, 2008
Time: Mon - Thurs 11:00a - 7:00p
Cost: $10 to cover insurance, good behavior/participation award, t-shirt and camp end cook-out
Contact Person: Sgt. Kim Nelson Phone: 843-495-3263
Director Mary Bess 843-393-1402
- Children 8yrs - 10yrs old must be signed in by parent/guardian and signed out promptly
by 6:30pm.
- Schedule of events will be posted each week.
- No loitering. Children must be engaged in planned activities.
- T-shirt size______.
My child ____________________________ has permission to attend Summer Camp 2008, on
June 9, 2008 through August 8, 2008 with the City of Darlington. I consent to the stated
conditions for the event. I further understand that if my child chooses behavior that is
inappropriate, I may be requested to remove my child from the camp at my own expense. My
child is in good physical condition at present and has had no serious illness or operations since
their last health examination.
I understand the cost will be: ______________________
I can be reached at H: W: C:
Please list names and phone numbers of two other responsible adults to call if we cannot reach
you in case of emergency (Please check with these contacts before listing them).
Name: Phone: H: C:
Name: Phone: H: C:
_________________________ _____________________________ ______
Print Parent/Guardian Name Signature Date