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2017 Tom Bass Camp Registration
June 12th – June 16th
Hours: 9:00am – 3:00pm @ Murphey Candler Park
Email address
Camper's Name
Camper's grade
Camper's Age
Home Phone
Cell Phone
Returning Camper?
Parent(s) Name(s)
Parent(s) Email(s)
Address
Method of Payment
Any info we should know about your child
Medical Insurance Carrier
Medical Insurance Policy Number
Are there any medical conditions that physicians should be aware of?
Emergency Contact Name (other then parent)
Emergency Contact Phone (other then parent)
Parent's Signature
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