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CAMP registration
Name
Age
Parent’s Name
Parent Phone Number
Camp Name
—Please choose a camp—
Camp I — July 21–25 9am-12pm
Camp II — July 28–August 1 9am-12pm
Camp III — August 4–August 8 9am-12pm
Camp IV — August 11–August 15 9am-12pm
Email Address
Please list any allergies.
Are the child’s vaccinations up-to-date?
—Please choose an option—
Yes
No
Does your child have any special needs or developmental delays?
—Please choose an option—
Yes
No
Please explain.
Child’s Physician Name
Physician Telephone Number
May we use your child’s photograph for our website and/or social media?
Select an option
Yes
No
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