X

Permission For The Release of Information

Please enable JavaScript in your browser to complete this form.

The purpose of this form is to give us permission to receive information from other professionals who work with your child. This allows us to better know your child during the application process and helps us determine whether or not Green Cove Day Camp will be a good match for them. In addition, should your child attend Green Cove, we will have the opportunity to communicate with those who know your child best throughout the summer. We will also be happy to share information about their camp experience with these same professionals once the summer is over.

IMPORTANT: Please ask the people listed below to complete the Professional Questionnaire portion of our online application on your child’s behalf. After receiving their written questionnaire, we will follow up with them as needed.

I, the undersigned, so hereby give my permission for Green Cove Day Camp and the following list of agencies or individuals to share information about my child:

Camper Name
PROFESSIONAL 1 (Teacher/School Professional)
  • United States+1
  • United Kingdom+44
  • Afghanistan+93
  • Albania+355
  • Algeria+213
  • American Samoa+1
  • Andorra+376
  • Angola+244
  • Anguilla+1
  • Antigua & Barbuda+1
  • Argentina+54
  • Armenia+374
  • Aruba+297
  • Ascension Island+247
  • Australia+61
  • Austria+43
  • Azerbaijan+994
  • Bahamas+1
  • Bahrain+973
  • Bangladesh+880
  • Barbados+1
  • Belarus+375
  • Belgium+32
  • Belize+501
  • Benin+229
  • Bermuda+1
  • Bhutan+975
  • Bolivia+591
  • Bosnia & Herzegovina+387
  • Botswana+267
  • Brazil+55
  • British Indian Ocean Territory+246
  • British Virgin Islands+1
  • Brunei+673
  • Bulgaria+359
  • Burkina Faso+226
  • Burundi+257
  • Cambodia+855
  • Cameroon+237
  • Canada+1
  • Cape Verde+238
  • Caribbean Netherlands+599
  • Cayman Islands+1
  • Central African Republic+236
  • Chad+235
  • Chile+56
  • China+86
  • Christmas Island+61
  • Cocos (Keeling) Islands+61
  • Colombia+57
  • Comoros+269
  • Congo - Brazzaville+242
  • Congo - Kinshasa+243
  • Cook Islands+682
  • Costa Rica+506
  • Croatia+385
  • Cuba+53
  • Curaçao+599
  • Cyprus+357
  • Czechia+420
  • Côte d’Ivoire+225
  • Denmark+45
  • Djibouti+253
  • Dominica+1
  • Dominican Republic+1
  • Ecuador+593
  • Egypt+20
  • El Salvador+503
  • Equatorial Guinea+240
  • Eritrea+291
  • Estonia+372
  • Eswatini+268
  • Ethiopia+251
  • Falkland Islands+500
  • Faroe Islands+298
  • Fiji+679
  • Finland+358
  • France+33
  • French Guiana+594
  • French Polynesia+689
  • Gabon+241
  • Gambia+220
  • Georgia+995
  • Germany+49
  • Ghana+233
  • Gibraltar+350
  • Greece+30
  • Greenland+299
  • Grenada+1
  • Guadeloupe+590
  • Guam+1
  • Guatemala+502
  • Guernsey+44
  • Guinea+224
  • Guinea-Bissau+245
  • Guyana+592
  • Haiti+509
  • Honduras+504
  • Hong Kong SAR China+852
  • Hungary+36
  • Iceland+354
  • India+91
  • Indonesia+62
  • Iran+98
  • Iraq+964
  • Ireland+353
  • Isle of Man+44
  • Israel+972
  • Italy+39
  • Jamaica+1
  • Japan+81
  • Jersey+44
  • Jordan+962
  • Kazakhstan+7
  • Kenya+254
  • Kiribati+686
  • Kosovo+383
  • Kuwait+965
  • Kyrgyzstan+996
  • Laos+856
  • Latvia+371
  • Lebanon+961
  • Lesotho+266
  • Liberia+231
  • Libya+218
  • Liechtenstein+423
  • Lithuania+370
  • Luxembourg+352
  • Macao SAR China+853
  • Madagascar+261
  • Malawi+265
  • Malaysia+60
  • Maldives+960
  • Mali+223
  • Malta+356
  • Marshall Islands+692
  • Martinique+596
  • Mauritania+222
  • Mauritius+230
  • Mayotte+262
  • Mexico+52
  • Micronesia+691
  • Moldova+373
  • Monaco+377
  • Mongolia+976
  • Montenegro+382
  • Montserrat+1
  • Morocco+212
  • Mozambique+258
  • Myanmar (Burma)+95
  • Namibia+264
  • Nauru+674
  • Nepal+977
  • Netherlands+31
  • New Caledonia+687
  • New Zealand+64
  • Nicaragua+505
  • Niger+227
  • Nigeria+234
  • Niue+683
  • Norfolk Island+672
  • North Korea+850
  • North Macedonia+389
  • Northern Mariana Islands+1
  • Norway+47
  • Oman+968
  • Pakistan+92
  • Palau+680
  • Palestinian Territories+970
  • Panama+507
  • Papua New Guinea+675
  • Paraguay+595
  • Peru+51
  • Philippines+63
  • Poland+48
  • Portugal+351
  • Puerto Rico+1
  • Qatar+974
  • Romania+40
  • Russia+7
  • Rwanda+250
  • Réunion+262
  • Samoa+685
  • San Marino+378
  • Saudi Arabia+966
  • Senegal+221
  • Serbia+381
  • Seychelles+248
  • Sierra Leone+232
  • Singapore+65
  • Sint Maarten+1
  • Slovakia+421
  • Slovenia+386
  • Solomon Islands+677
  • Somalia+252
  • South Africa+27
  • South Korea+82
  • South Sudan+211
  • Spain+34
  • Sri Lanka+94
  • St. Barthélemy+590
  • St. Helena+290
  • St. Kitts & Nevis+1
  • St. Lucia+1
  • St. Martin+590
  • St. Pierre & Miquelon+508
  • St. Vincent & Grenadines+1
  • Sudan+249
  • Suriname+597
  • Svalbard & Jan Mayen+47
  • Sweden+46
  • Switzerland+41
  • Syria+963
  • São Tomé & Príncipe+239
  • Taiwan+886
  • Tajikistan+992
  • Tanzania+255
  • Thailand+66
  • Timor-Leste+670
  • Togo+228
  • Tokelau+690
  • Tonga+676
  • Trinidad & Tobago+1
  • Tunisia+216
  • Turkey+90
  • Turkmenistan+993
  • Turks & Caicos Islands+1
  • Tuvalu+688
  • U.S. Virgin Islands+1
  • Uganda+256
  • Ukraine+380
  • United Arab Emirates+971
  • United Kingdom+44
  • United States+1
  • Uruguay+598
  • Uzbekistan+998
  • Vanuatu+678
  • Vatican City+39
  • Venezuela+58
  • Vietnam+84
  • Wallis & Futuna+681
  • Western Sahara+212
  • Yemen+967
  • Zambia+260
  • Zimbabwe+263
  • Åland Islands+358
Address
PROFESSIONAL 2
  • United States+1
  • United Kingdom+44
  • Afghanistan+93
  • Albania+355
  • Algeria+213
  • American Samoa+1
  • Andorra+376
  • Angola+244
  • Anguilla+1
  • Antigua & Barbuda+1
  • Argentina+54
  • Armenia+374
  • Aruba+297
  • Ascension Island+247
  • Australia+61
  • Austria+43
  • Azerbaijan+994
  • Bahamas+1
  • Bahrain+973
  • Bangladesh+880
  • Barbados+1
  • Belarus+375
  • Belgium+32
  • Belize+501
  • Benin+229
  • Bermuda+1
  • Bhutan+975
  • Bolivia+591
  • Bosnia & Herzegovina+387
  • Botswana+267
  • Brazil+55
  • British Indian Ocean Territory+246
  • British Virgin Islands+1
  • Brunei+673
  • Bulgaria+359
  • Burkina Faso+226
  • Burundi+257
  • Cambodia+855
  • Cameroon+237
  • Canada+1
  • Cape Verde+238
  • Caribbean Netherlands+599
  • Cayman Islands+1
  • Central African Republic+236
  • Chad+235
  • Chile+56
  • China+86
  • Christmas Island+61
  • Cocos (Keeling) Islands+61
  • Colombia+57
  • Comoros+269
  • Congo - Brazzaville+242
  • Congo - Kinshasa+243
  • Cook Islands+682
  • Costa Rica+506
  • Croatia+385
  • Cuba+53
  • Curaçao+599
  • Cyprus+357
  • Czechia+420
  • Côte d’Ivoire+225
  • Denmark+45
  • Djibouti+253
  • Dominica+1
  • Dominican Republic+1
  • Ecuador+593
  • Egypt+20
  • El Salvador+503
  • Equatorial Guinea+240
  • Eritrea+291
  • Estonia+372
  • Eswatini+268
  • Ethiopia+251
  • Falkland Islands+500
  • Faroe Islands+298
  • Fiji+679
  • Finland+358
  • France+33
  • French Guiana+594
  • French Polynesia+689
  • Gabon+241
  • Gambia+220
  • Georgia+995
  • Germany+49
  • Ghana+233
  • Gibraltar+350
  • Greece+30
  • Greenland+299
  • Grenada+1
  • Guadeloupe+590
  • Guam+1
  • Guatemala+502
  • Guernsey+44
  • Guinea+224
  • Guinea-Bissau+245
  • Guyana+592
  • Haiti+509
  • Honduras+504
  • Hong Kong SAR China+852
  • Hungary+36
  • Iceland+354
  • India+91
  • Indonesia+62
  • Iran+98
  • Iraq+964
  • Ireland+353
  • Isle of Man+44
  • Israel+972
  • Italy+39
  • Jamaica+1
  • Japan+81
  • Jersey+44
  • Jordan+962
  • Kazakhstan+7
  • Kenya+254
  • Kiribati+686
  • Kosovo+383
  • Kuwait+965
  • Kyrgyzstan+996
  • Laos+856
  • Latvia+371
  • Lebanon+961
  • Lesotho+266
  • Liberia+231
  • Libya+218
  • Liechtenstein+423
  • Lithuania+370
  • Luxembourg+352
  • Macao SAR China+853
  • Madagascar+261
  • Malawi+265
  • Malaysia+60
  • Maldives+960
  • Mali+223
  • Malta+356
  • Marshall Islands+692
  • Martinique+596
  • Mauritania+222
  • Mauritius+230
  • Mayotte+262
  • Mexico+52
  • Micronesia+691
  • Moldova+373
  • Monaco+377
  • Mongolia+976
  • Montenegro+382
  • Montserrat+1
  • Morocco+212
  • Mozambique+258
  • Myanmar (Burma)+95
  • Namibia+264
  • Nauru+674
  • Nepal+977
  • Netherlands+31
  • New Caledonia+687
  • New Zealand+64
  • Nicaragua+505
  • Niger+227
  • Nigeria+234
  • Niue+683
  • Norfolk Island+672
  • North Korea+850
  • North Macedonia+389
  • Northern Mariana Islands+1
  • Norway+47
  • Oman+968
  • Pakistan+92
  • Palau+680
  • Palestinian Territories+970
  • Panama+507
  • Papua New Guinea+675
  • Paraguay+595
  • Peru+51
  • Philippines+63
  • Poland+48
  • Portugal+351
  • Puerto Rico+1
  • Qatar+974
  • Romania+40
  • Russia+7
  • Rwanda+250
  • Réunion+262
  • Samoa+685
  • San Marino+378
  • Saudi Arabia+966
  • Senegal+221
  • Serbia+381
  • Seychelles+248
  • Sierra Leone+232
  • Singapore+65
  • Sint Maarten+1
  • Slovakia+421
  • Slovenia+386
  • Solomon Islands+677
  • Somalia+252
  • South Africa+27
  • South Korea+82
  • South Sudan+211
  • Spain+34
  • Sri Lanka+94
  • St. Barthélemy+590
  • St. Helena+290
  • St. Kitts & Nevis+1
  • St. Lucia+1
  • St. Martin+590
  • St. Pierre & Miquelon+508
  • St. Vincent & Grenadines+1
  • Sudan+249
  • Suriname+597
  • Svalbard & Jan Mayen+47
  • Sweden+46
  • Switzerland+41
  • Syria+963
  • São Tomé & Príncipe+239
  • Taiwan+886
  • Tajikistan+992
  • Tanzania+255
  • Thailand+66
  • Timor-Leste+670
  • Togo+228
  • Tokelau+690
  • Tonga+676
  • Trinidad & Tobago+1
  • Tunisia+216
  • Turkey+90
  • Turkmenistan+993
  • Turks & Caicos Islands+1
  • Tuvalu+688
  • U.S. Virgin Islands+1
  • Uganda+256
  • Ukraine+380
  • United Arab Emirates+971
  • United Kingdom+44
  • United States+1
  • Uruguay+598
  • Uzbekistan+998
  • Vanuatu+678
  • Vatican City+39
  • Venezuela+58
  • Vietnam+84
  • Wallis & Futuna+681
  • Western Sahara+212
  • Yemen+967
  • Zambia+260
  • Zimbabwe+263
  • Åland Islands+358
Address
Professional 3
  • United States+1
  • United Kingdom+44
  • Afghanistan+93
  • Albania+355
  • Algeria+213
  • American Samoa+1
  • Andorra+376
  • Angola+244
  • Anguilla+1
  • Antigua & Barbuda+1
  • Argentina+54
  • Armenia+374
  • Aruba+297
  • Ascension Island+247
  • Australia+61
  • Austria+43
  • Azerbaijan+994
  • Bahamas+1
  • Bahrain+973
  • Bangladesh+880
  • Barbados+1
  • Belarus+375
  • Belgium+32
  • Belize+501
  • Benin+229
  • Bermuda+1
  • Bhutan+975
  • Bolivia+591
  • Bosnia & Herzegovina+387
  • Botswana+267
  • Brazil+55
  • British Indian Ocean Territory+246
  • British Virgin Islands+1
  • Brunei+673
  • Bulgaria+359
  • Burkina Faso+226
  • Burundi+257
  • Cambodia+855
  • Cameroon+237
  • Canada+1
  • Cape Verde+238
  • Caribbean Netherlands+599
  • Cayman Islands+1
  • Central African Republic+236
  • Chad+235
  • Chile+56
  • China+86
  • Christmas Island+61
  • Cocos (Keeling) Islands+61
  • Colombia+57
  • Comoros+269
  • Congo - Brazzaville+242
  • Congo - Kinshasa+243
  • Cook Islands+682
  • Costa Rica+506
  • Croatia+385
  • Cuba+53
  • Curaçao+599
  • Cyprus+357
  • Czechia+420
  • Côte d’Ivoire+225
  • Denmark+45
  • Djibouti+253
  • Dominica+1
  • Dominican Republic+1
  • Ecuador+593
  • Egypt+20
  • El Salvador+503
  • Equatorial Guinea+240
  • Eritrea+291
  • Estonia+372
  • Eswatini+268
  • Ethiopia+251
  • Falkland Islands+500
  • Faroe Islands+298
  • Fiji+679
  • Finland+358
  • France+33
  • French Guiana+594
  • French Polynesia+689
  • Gabon+241
  • Gambia+220
  • Georgia+995
  • Germany+49
  • Ghana+233
  • Gibraltar+350
  • Greece+30
  • Greenland+299
  • Grenada+1
  • Guadeloupe+590
  • Guam+1
  • Guatemala+502
  • Guernsey+44
  • Guinea+224
  • Guinea-Bissau+245
  • Guyana+592
  • Haiti+509
  • Honduras+504
  • Hong Kong SAR China+852
  • Hungary+36
  • Iceland+354
  • India+91
  • Indonesia+62
  • Iran+98
  • Iraq+964
  • Ireland+353
  • Isle of Man+44
  • Israel+972
  • Italy+39
  • Jamaica+1
  • Japan+81
  • Jersey+44
  • Jordan+962
  • Kazakhstan+7
  • Kenya+254
  • Kiribati+686
  • Kosovo+383
  • Kuwait+965
  • Kyrgyzstan+996
  • Laos+856
  • Latvia+371
  • Lebanon+961
  • Lesotho+266
  • Liberia+231
  • Libya+218
  • Liechtenstein+423
  • Lithuania+370
  • Luxembourg+352
  • Macao SAR China+853
  • Madagascar+261
  • Malawi+265
  • Malaysia+60
  • Maldives+960
  • Mali+223
  • Malta+356
  • Marshall Islands+692
  • Martinique+596
  • Mauritania+222
  • Mauritius+230
  • Mayotte+262
  • Mexico+52
  • Micronesia+691
  • Moldova+373
  • Monaco+377
  • Mongolia+976
  • Montenegro+382
  • Montserrat+1
  • Morocco+212
  • Mozambique+258
  • Myanmar (Burma)+95
  • Namibia+264
  • Nauru+674
  • Nepal+977
  • Netherlands+31
  • New Caledonia+687
  • New Zealand+64
  • Nicaragua+505
  • Niger+227
  • Nigeria+234
  • Niue+683
  • Norfolk Island+672
  • North Korea+850
  • North Macedonia+389
  • Northern Mariana Islands+1
  • Norway+47
  • Oman+968
  • Pakistan+92
  • Palau+680
  • Palestinian Territories+970
  • Panama+507
  • Papua New Guinea+675
  • Paraguay+595
  • Peru+51
  • Philippines+63
  • Poland+48
  • Portugal+351
  • Puerto Rico+1
  • Qatar+974
  • Romania+40
  • Russia+7
  • Rwanda+250
  • Réunion+262
  • Samoa+685
  • San Marino+378
  • Saudi Arabia+966
  • Senegal+221
  • Serbia+381
  • Seychelles+248
  • Sierra Leone+232
  • Singapore+65
  • Sint Maarten+1
  • Slovakia+421
  • Slovenia+386
  • Solomon Islands+677
  • Somalia+252
  • South Africa+27
  • South Korea+82
  • South Sudan+211
  • Spain+34
  • Sri Lanka+94
  • St. Barthélemy+590
  • St. Helena+290
  • St. Kitts & Nevis+1
  • St. Lucia+1
  • St. Martin+590
  • St. Pierre & Miquelon+508
  • St. Vincent & Grenadines+1
  • Sudan+249
  • Suriname+597
  • Svalbard & Jan Mayen+47
  • Sweden+46
  • Switzerland+41
  • Syria+963
  • São Tomé & Príncipe+239
  • Taiwan+886
  • Tajikistan+992
  • Tanzania+255
  • Thailand+66
  • Timor-Leste+670
  • Togo+228
  • Tokelau+690
  • Tonga+676
  • Trinidad & Tobago+1
  • Tunisia+216
  • Turkey+90
  • Turkmenistan+993
  • Turks & Caicos Islands+1
  • Tuvalu+688
  • U.S. Virgin Islands+1
  • Uganda+256
  • Ukraine+380
  • United Arab Emirates+971
  • United Kingdom+44
  • United States+1
  • Uruguay+598
  • Uzbekistan+998
  • Vanuatu+678
  • Vatican City+39
  • Venezuela+58
  • Vietnam+84
  • Wallis & Futuna+681
  • Western Sahara+212
  • Yemen+967
  • Zambia+260
  • Zimbabwe+263
  • Åland Islands+358
Address

I understand that this information will be kept confidential by Green Cove Day Camp and will not be released to any agencies or parties not listed above without further consent.

Clear Signature