LLCA Kindergarten Camp Registration Form 2019
Free Kindergarten Camp July 31 - August 1, 2019 9 am-12 noon
Student must be five on or before August 31, 2019 in order to meet requirements for kindergarten.
Email address *
Students Name (last, first) *
Your answer
Date of Birth *
MM
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DD
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YYYY
Parent/Guardian Name *
Your answer
Parent/Guardian Phone Number *
Your answer
Parent/Guardian Email Address
Your answer
Parent/Guardian Name *
Your answer
Parent/Guardian Phone Number *
Your answer
Parent/Guardian Email Address
Your answer
Address (Please include street number, street name, city and zip) *
Your answer
County of Residence *
Medical Allergies *
Your answer
Medical Alerts *
Your answer
Current Medications *
Your answer
Emergency Contact 1 (other than parent) *
Your answer
Emergency Contact 1 Phone Number *
Your answer
Emergency Contact 2 (other than parent) *
Your answer
Emergency Contact 2 Phone Number *
Your answer
Emergency Contact 3 (other than parent)
Your answer
Emergency Contact 3 Phone Number
Your answer
Custody Issues? *
Is your child enrolled for LLCA for 2019-2020? *
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