Walk/Bike Permission Form

I give my child:

1. Name of Child

permission to:

2. Walk or Bike

Walk
Bike

3. to Name of Camp/Program Location:

4. and from (Name of Camp/Program Location):

5. On the following days:

6. My child will arrive to camp by (time):

7. and will depart camp by (time):

My child understands that he/she will sign him/herself in and out of camp each day. I understand that the Prince William County Department of Parks and Recreation is not responsible for my child’s supervision or well-being on the way to or from the camp location listed above. If my child will not be in attendance on one of the above mentioned days, I will contact the camp location to inform them any changes in my child’s schedule.

8. Parent/Guardian Signature *This question is required.

Clear

Signature of

9. I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent. *This question is required.

I agree

10. Date (Month, Day, Year) This question requires a valid date format of MM/DD/YYYY.

calendar

11. Your E-mail Address (to receive a PDF copy of your responses) *This question is required. This question requires a valid email address.