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Home Phone*   Cell Phone
 
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Student First Name*   Student Last Name*
 
Student Age*
4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21+

Child Grade in September (for kids and teens only)

Allergies


Emergency Contact Name*   Emergency Contact Phone*
 
Person Authorized to Pick Up Child (for Adult Camp, type "n/a")*

Special Instructions