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2. Pick Up Authorization Form
4. Camper's Name*
5. Gender*
7. Birthday (MM/DD/YY)*
8. Age*
9. Grade*
11. Home Address*
12. City, State, Zip*

14. Authorized to pick up
16. Parent/Guardian Name*
17. Birthday*
19. Phone*
20. Valid State ID Number*
24. Parent/Guardain Name
25. Birthday
27. Phone
28. Valid State ID Number
32. Name and Relationship
33. Birthday
35. Phone
36. Valid State ID Number
40. Name and Relationship
41. Birthday
43. Phone
44. Valid State ID Number
48. Name and Relationship
49. Birthday
51. Phone
52. Valid State ID Number

56. Only those listed above, with all required information, will be authorized to pick up a camper. Those listed must provide their valid state identification card when picking up the camp. No camper will be allowed to leave without proper identification of an authorized person as shown above. If there is an emergency, and an authorized person is not able to pick up the camper, please call the Branson RecPlex at (417) 335-2368 and provide all necessary information. 

58. Acknowledgement*

    By clicking "Accept" below, you acknowledge:

    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, its 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 minor’s photo may be used to document or market this program.

    1. Accept
Leave This Blank:


60. 1. Receive an email copy of this form.
61. Email address

    This field is not part of the form submission.

62. Submit

* indicates a required field