Please provide information below that will help us to create a safe and healthy environment for your child. Lack
of detailed information compromises our staff’s ability to successfully accommodate your child. The Carol
Stream Park District is not responsible for any injuries, complications, damages or losses due to lack of provided
information. Many resources and adaptations are available to assist your child in having a successful summer.
If your child has medication that may need to be administered by CSPD staff or medication that may need to
be self-administered (including asthma inhalers), please complete the Permission to Dispense Medication Form.
If your child will self-administer or need staff to administer medication (including asthma inhalers, epi-pens, or any other medications) while at camp, a Permission to Dispense Medication Form must be completed.
Please note that a minimum of two weeks is required in order to secure a one-on-one assistant.
Authorized Contact and Release Information
Parents/Guardians listed earlier with custody already have pick-up authorization. Please list siblings, parents without custody, relatives or friends who are also authorized to pick-up your child. All individuals must present a picture I.D. in order for your child to be released into their custody. Only the custodial parent may approve changes or additions to this list. For emergency purposes, at least one authorized person must live within five miles of Carol Stream.
First Authorized Individual
Second Authorized Individual
Third Authorized Individual
Fourth Authorized Individual
Fifth Authorized Individual