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SCHEDULE YOUR LESSON
CAMPER REGISTRATION FORM
CAMPER INFORMATION
Child’s Name
*
Child’s Age
*
Child’s Birth Date
*
Month
Month
Day
Year
Child’s Grade
*
Parent/Guardian Name(s)
*
Phone
*
Email
*
EMERGENCY INFORMATION
Emergency Contact 1
*
Phone
*
Emergency Contact 1
Phone
Doctor
Phone
*
Allergies or Special Needs
*
DISMISSAL
Who may pick up your child at the end of each camp day?
Name:
*
Relationship:
*
Name:
*
Relationship:
*
Parent/Guardian Signature:
*
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