Please complete all information (use one form for each camper), sign, date, and return to:
Camp Cherith Registrar,

Dear Parent,
Your child's safety is of great concern to us. Therefore, we ask that you give
us the name of the individual who will be picking up your camper on departure day.
Please fill out the form below with information requested.

If it should become necessary for someone other than the person listed to pick up
your camper, please call the camp before the end of the week.
Camp phone: (610)273-3969 / (302)738-8186.

Please retain this portion of the form so that you will have the camp phone number
in case you need to advise us of a change in plans.

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(detach and return lower portion to registrar or camp)

Parent name Phone
My childwill be picked up at camp or camp bus stop on
by:
        (Date)


(Choose One)
Parent of Legal Guardian
                                                                                      Name

Other Individual
                                                                       Name

Church Vehicle Driver or Church Name
                                                                                 Name

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FOR OFFICE USE: