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2. Your Name (Parent or Legal Guardian of Child)
4. First Name
5. Last Name*
7. Your Email Address*
9. Name of Child/Participant
11. Child/Participant's First Name*
12. Child/Participants's Last Name*
14. Photo Opt-Out
    Photos of my child/participant MAY NOT be published for publicity purposes including flyers, emails, websites, activity guides, press releases or any other mass production that is distributed.
16. Verification*

    1. In submitting this form, I acknowledge that I am this child's legal guardian (or the participant), and I have the authority to make this request.
18. Duration - YOU ONLY NEED TO FILL THIS FORM OUT ONCE
    Your child/participant will remain on the opt-out list until a written notification is received by the Recreation & Community Services Department requesting the removal of your child/participant. To alter this request please email recreation@cityofcampbell.com. Please do not resubmit this form for each activity/season/year.
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20. 1. Receive an email copy of this form.
21. Email address

    This field is not part of the form submission.

22. Submit Submit and Print

* indicates a required field