Professional References

Information Release

Campers playing a game of Magic on a Rustic Overnight Retreat

CAMP SEQUOIA PERMISSION FOR THE RELEASE OF INFORMATION FORM

Parents: The purpose of this form is to give us permission to receive information from professionals who work with your child in the school setting and see them regularly interacting with peers. This helps us determine whether Camp Sequoia will be a good match for him.

This form should be filled out by you and given to your child’s school so they know you have authorized the individuals filling out these questionnaires to share information with us. Camp Sequoia also will need a copy of this form for our records.

IMPORTANT: Please have these questionnaires completed as soon as possible. We will follow up with questions or concerns after receiving these materials.

I understand that this information will be kept confidential by Camp Sequoia and will not be released to any agencies or parties without further consent.
I, the undersigned, do hereby give my permission for Camp Sequoia to obtain and/or share information about my child.
Parent's Name*

First

Last
Parent's Email*
Parent's Phone
Child's Name*

First

Last
Professional 1*
Professional 2*
Consent*
I agree to the privacy policy.

By checking this box, I authorize the professionals named in this form to provide a reference for my child.
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