camp apollo teen travel po box 34 plainview, new york 11803 938 ...

CAMP APOLLO TEEN TRAVEL
P.O. BOX 34
PLAINVIEW, NEW YORK 11803
938-2670
www.campapollo.com
RE: Overnight trip to Niagara Falls and Toronto
August 2 – August 5, 2010
Dear Parents:
We have been informed by the Immigration and Customs
Service that we are required to have a signed and notarized
permission slip granting permission to take your child across an
international border.
This notarized permission must be from both parents and/or
guardians. Please submit the notarized permission form no later
than July 6 th . We will be unable to take your child on this
overnight without this document.
Please be advised that your child will need either a birth
certificate with a raised seal or a current passport for this trip.
This official document must be submitted on or before Monday
July 26, 2010.

CAMP APOLLO – CANADA TRIP
Camper’s Name __________________________________________________________
(Please Print)
TO WHOM IT MAY CONCERN:
We, ___________________________________ and _____________________________________,
(Full Name of Parents/Guardians)
are the lawful Parents/Guardians of ___________________________________________________,
(Full Name of Child)
born on ________________________, who is enrolled as a camper at Camp Apollo, located at
(Date of Birth)
Plainview, New York for the 2010 Summer Camp Program.
Our child, __________________________________, has our consent to travel with Camp Apollo to
(Name of Child)
visit Canada for four (4) consecutive days.
______________________________ ____________________________________ _____________
Print Name Signature of Custodial Parent or Guardian Date
STATE OF NEW YORK)
)ss:
COUNTY OF NASSAU)
On the day of in the year 2010 before me, the undersigned, personally
appeared
, personally known to me or proved to me on the basis of
satisfactory evidence to be the individual(s) whose name(s) are subscribed to the within instrument and
acknowledged to me that he/she/they executed the same in their capacity(ies) and that by his/her/their
signatures on the instrument, the individual(s), or the person upon behalf of which the individual(s) acted,
executed the instrument.
_________________________________
Signature and Office of individual
Taking the acknowledgement
______________________________ ____________________________________ _____________
Print Name Signature of Custodial Parent or Guardian Date
STATE OF NEW YORK)
)ss:
COUNTY OF NASSAU)
On the day of in the year 2010 before me, the undersigned, personally
appeared
, personally known to me or proved to me on the basis of
satisfactory evidence to be the individual(s) whose name(s) are subscribed to the within instrument and
acknowledged to me that he/she/they executed the same in their capacity(ies) and that by his/her/their
signatures on the instrument, the individual(s), or the person upon behalf of which the individual(s) acted,
executed the instrument.
_________________________________
Signature and Office of individual
Taking the acknowledgement