Student Release Form

The Student Release Form should be completed for EACH student ages 3–5. This form only needs to be submitted once per year for all campers, regardless of age, even if your child will attend multiple camps during the summer.

Student Release Form

Check one:(Required)
Camper Name(Required)
Current week or first camp attending

Parent/Guardian Information

Parent/Guardian 1: Contact Information
Parent/Guardian 2: Contact Information

Authorization for Release

COCA’s system only allows two authorized individuals (other than parents/guardians) to be listed. Contact COCA’s Registration Office if there are changes.
Authorized Individual 1
Person 1: Name
Authorized Individual 2
Person 2: Name

Parent/Guardian Signature

MM slash DD slash YYYY
This field is for validation purposes and should be left unchanged.

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