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Application

Application*
I understand this application does not guarantee acceptance to the ACCPD Summer Camp. I will be contacted within five (5) days if my child/children has been accepted or placed on the wait list. Type "YES" in the above box if you agree.
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Please complete this form that will accompany your child during the Athens-Clarke County Police Department Youth Summer Camp. This information is necessary should we need to contact you. No child will be allowed to participate without this form being completed and signed by the parent or guardian. The information on this form is considered confidential.
Permission is granted for:*
(Name of Student)
Shirt size (adult sizes)*
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Medical Release*
1. I hereby authorize the release of my child's pertinent medical information to the appropriate professional staff. I give permission to the physician or hospital to secure treatment for him/her and to
Doctor:
Phone Number:
Insurance carrier:
Policy / Group Number:
Parent/Legal guardian name*
Date:*
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The Athens-Clarke County Police Department (“ACCPD”) has planned many field trips throughout each week of the program. As a convenience, we would like to extend a permission slip that will suffice for all planned activities during the 2022 Athens-Clarke County Youth Summer Camp. All field trips and admission will be paid for by ACCPD, but your child may bring additional money. By signing this permission slip, you are granting permission for your child to attend ALL scheduled field trips during the 2022 Summer Camp.
Field Trips Scheduled include: (This is a tentative list and is subject to change)!
- Skating, Bowling, Movie Theatre
- Georgia Museum of Art
- Funopolis
- Foley Field
Permission*
As a parent/legal guardian for the child named below, I grant permission for my child to participate in the 2022 Athens-Clarke County Police Department Youth Summer Camp
1. Yes, I do grant permission
2. No, I do not grant permission
For questions concerning the ACCPD Youth Summer Camp, contact either:
- NSO Lesley Moore at 762-400-7159 or at lesley.moore@accgov.com

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