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Tiny Mindful Moments Summer Kids Series
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Participant Name *
Participant Date of Birth *
Participant Gender *
Parent/Guardian Name *
Parent/Guardian Phone Number *
Parent/Guardian Email Address *
Does the camper have any allergies? If yes, please list. *
Does the camper have any chronic conditions or need medication during camp? If yes, please provide details:
 *
Please select the program(s) the camper will be participating in:
Daily Option: $30/Day
T-Shirt Size (for campers)
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Payment Type ($120/Session)
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