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2019 Summer Camp Registration
Camp Fidelis 2019
Email address *
Childs First Name *
Your answer
Child's Last Name *
Your answer
Gender *
Date of Birth
MM
/
DD
/
YYYY
Fall 2019 School Grade
Parent/Guardian 1 First Name, Last Name *
Your answer
Parent/Guardian 1 Home Address *
Your answer
Parent/Guardian 1 Phone Number (Primary) *
Your answer
Parent/Guardian 1 Phone Number (Alternate)
Your answer
Parent/Guardian 1 Place of Employment
Your answer
Is Parent/Guardian 1 allowed to pickup? *
Parent/Guardian 1 Relationship to child? *
Your answer
Parent/Guardian 2 First Name, Last Name
Your answer
Parent/Guardian 2 Home Address (if different from Parent/Guardian 1
Your answer
Parent/Guardian 2 Phone Number (Primary)
Your answer
Parent/Guardian 2 Phone Number (Alternate)
Your answer
Parent/Guardian 2 Place of Employment
Your answer
Is Parent/Guardian 2 Allowed to Pickup?
Parent/Guardian 2 Relationship to child
Your answer
Emergency Contact 1 First Name, Last Name *
Your answer
Emergency Contact 1 Telephone Number *
Your answer
Emergency Contact 2 First Name, Last Name *
Your answer
Emergency Contact 2 Telephone Number *
Your answer
Emergency Contact-Additional
Your answer
Weeks Camper will be at Camp Fidelis (You must select at least one week) *
Required
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