Name of Camper:________________________________________ Week(s) Attending: (please circle) July 4 - 8 – M, Tu, W, Th, F or full week July 11 - 15 - M, Tu, W, Th, F or full week July 18- 22 - M, Tu, W, Th, F or full week July 25 - 29 - M, Tu, W, Th, F or full week August 1 - 5 - CLOSED August 8 - 12 - M, Tu, W, Th, F or full week August 15 - 19 - M, Tu, W, Th, F or full week August 22 - 26 - M, Tu, W, Th, F or full week August 92 - Sep 2 - M, Tu, W, Th, F or full week NAME OF PERSON OR PERSON(S) WHO WILL BE PICKING YOUR CHILD/CHILDREN UP AT THE END OF THE DAY _______________________________________________________ IF ANY OTHER PERSON WILL BE COMING TO PICK YOUR CHILD/CHILDREN UP PLEASE NOTIFY US. EGALACRES FARM CAMP WILL NOT RELEASE THE CAMPER(S) IF WE ARE NOT NOTIFIED. Signature: _____________________________________ Date: _________________________________________