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Capernaum Summer Camp Registration 2017
Rockbridge, August 12-16 2017
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Camper First Name
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Your answer
Camper Last Name
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Your answer
Address
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Your answer
Address 2 (apt. #, P.O. Box, etc.)
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City
*
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State
*
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Home Phone
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Cell Phone
*
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Contact Email
*
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Camper Gender
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Male
Female
Birth Date
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MM
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DD
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YYYY
T-Shirt Size
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All Shirts in adult sizes
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Small
Medium
Large
X-Large
XX-Large
School
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Child Age
*
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Parent/Guardian Name 1
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Parent/Guardian Name 2
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Dietary Notes
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