Authorization to Leave Camp Premises

for Camp Sagitawa

Dear Guardian;

Since the staff member below is under 19, Camp Sagitawa requires that he/she have authorization from the legal guardian to leave the camp premises from time to time. This authorization is not open ended from the Camp’s perspective since any trip off the premises will require onsite permission from the Camp Director, Office Manager, or another adult leadership directly responsible for this staff member.

This form is valid only for the current year after which it was signed.

To be filled out by Guardian only.

* Required field


Name of Staff Member*

If you have specific concerns (i.e. weekend overnight trips, regularity, age of group, etc) please address them below.

Additional concerns / parameters:
Date signed
Print Full Guardian Name*
Guardian Signature (clicking is intent to sign)