SUMMER CAMP 2018


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Participant Details

First Child Name:

Date of Birth:

Gender:

Parent/Guardian Name:

Home Address:

City/State/Zip:

Phone Number:

Email Address:

Does your child have any allergies or medical conditions? If yes, please explain:


Do you want to include other child in your family?
Yes
No











Please select:
 

I give permission for my child/children to join the activities.
Parent/Guardian Signature: