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Pick Up Authorization Form

  1. Gender*

  2. Has your child completed Kindergarten?*

  3. Authorized to Pick Up

  4. Authorized to Pick Up

  5. Non-Parent/Guardian Authorized to Pick UP

  6. Non-Parent/Guardian Authorized to Pick Up

  7. Non-Parent/Guardian Authorized to Pick Up

  8. Only those listed above, with all required information, will be authorized to pick up a child/camper. Those listed are also asked to show their valid driver’s license when picking up the camper. No camper will be allowed to leave the Summer Day Camp unless proper identification of an authorized person is shown. If there is an emergency, and an authorized person is not able to pick up the camper, please call the RecPlex and provide all the information necessary to the Day Camp Director or Parks Assistant Director.

  9. Acknowledgement*

    I am the parent/legal guardian of the above named minor. I hereby waive, release and forever discharge all claims against the City of Branson, it’s employees, volunteers, commissioners or agents for damages and/or injuries that may arise from participation in the above named program. I hereby authorize any duly licensed physician, emergency medical technician or medical facility to treat the above named minor for injuries that may be received while participating in the program. I also understand that my child’s photo may be used to document or market this program.

  10. Leave This Blank:

  11. This field is not part of the form submission.