Emergency Contact & Authorized Pickup Form
One (1) Authorized Pickup Form is Required per FAMILY

To ensure the safety of all of Summer Fun at the JCC Camps at Medford participants, an emergency contact and authorized pickup form will be required for all families. This form will indicate which adults are permitted to pickup participants at any time within the program and who should be contacted in the event we are unable to contact the primary caregivers. Only authorized individuals listed on this form will be permitted to pickup a participant. Exceptions will only be made with written approval prior to the pick-up process. Authorized individuals must be 18 years of age or older.

If someone other than a person on this list must pick-up your child, please contact the camp office no later than 2 PM.  That person will then be required to show photo identification at the time of pick-up.
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Parent/Guardian Name *
Participant 1 Full Name *
Participant 2 Full Name
Participant 3 Full Name
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