John W. Cafourek (503) 587-7053

Director—Northwest Preteen

P.O. Box 5965

Salem, OR 97304

Transportation Form

Dear Parents, Campers, and Staff:

Welcome to Northwest Preteen Camp! In order to ensure the safe, orderly and authorized arrival and departure of all campers and staff to and from camp, we are asking that campers, parents and staff read and follow the procedures below. Please fillout and sign the information and authorization form, and send it back to the address below no later than June 1, 2012.

Arrival –Upon arrival,park in the lower parking area next to the swimming pool. (Bring a lunch as no lunch will be served on Sunday.)

  • Staff should arrive at10 a.m.,Sunday, August 5, 2012, location to be announced.
  • Campers should arrive at 1 p.m.

Registration – Campers will generally be registered by a parent, guardian, driver, or other responsible party who has been authorized by the parents or legal guardians of the child. Then campers will go to the nurse's station for medical screening and finally be escorted by a staff member tothe dorm area in the gym. UYC assumes supervisory responsibility for campers when registration and medical screening are complete. UYC relinquishes responsibility when the camper is signed out at the end of camp.

Departure–Upon arrival, park in the lower parking area next to the swimming pool.

  • The Award Ceremony will be 2 p.m. in the Pavilion Auditorium. Parents, please join us.
  • Go to your camper’s dorm and CHECK OUT with the COUNSELOR between 3 and 4 p.m.The counselor must have your signature that you have taken your camper from the dorm.

Changes – If your plans change after you send in this form, please call or E-mail Mr. Cafourek, (503) 587-7053, o inform him of any changes or cancellations.

Cut at dotted line and mail section below no later than June 1, 2012 to:

Northwest Preteen Camp 2012, PO BOX 5965, Salem, OR 97304

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Northwest Preteen Camp 2012: Arrival & Departure Authorization and Information Form

Nameof Camper or Staff:

Last NameFirst Name

Arrival August 5, 2012
I will be brought to camp by:
Driver’s name: (please print)
Emergency #: / Departure August 8, 2012
I will be picked up from camp by:
Driver’s name
(please print)
If there is any individual who under no circumstances would be allowed to pick up my child, please list that person(s) here:
Emergency #

I have fully read, understood and intend to comply with the procedures and rules listed on this form. To the best of my knowledge the above information is complete and accurate. I (if parent of a minor participant) also authorize the above listed person(s) to transport my child to and/or from Camp Osage, and to register and/or sign-out him/her as needed and required.

Signature of Parent or Adult Staff MemberSignature of Minor Staff MemberDate