Overnight Permission Form

Please fill out the form below as your permission slip for your student to attend our special overnight mentorship program. Boys overnight will be Tuesday night and the girls will be on Wednesday night the week of August 1st. This program is not offered to all Legacy Camper students. Your student or students were chosen by our Camp Director and have shown over the summer that they understand the legacy of students we are trying to create at Apple Ridge Farm. This is a privilege for these students and we expect them to be on their best behavior on their overnight trip.

If you have any questions please contact Jordan Bell at 540-353-1865

Thank you!

Student's First Name*
Student's Last Name*
Parent/Guardian First Name*
Parent/Guardian Last Name*
Parent/Guardian Email Address*
Parent/Guardian Phone Number*
Parent/Guardian Alternate Phone Number*
Are there any health concerns or medications that we need to be aware of?*
Emergency Contact 1 Name*
Emergency Contact 1 Home Address*
Emergency Contact 1 Phone Number*
Emergency Contact 2 Name*
Emergency Contact 2 Home Address*
Emergency Contact 2 Phone Number*
Consent*
I give permission for my child to attend a 2 day, 1 night, (Boys Tuesday, Girls Wednesday) special mentorship overnight. My health form and summer camp release information is still correct and I still agree to those terms and policies.
Type your full name below as your signature on this permission slip.*

Overnight Permission Form

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