LTCHS RAIDER BASKETBALL CAMP 2018 Camp dates: Monday July 9 to Friday July 13
(USE ONE FORM PER PARTICIPANT)
LAST NAME of participant *
Your answer
FIRST NAME of participant *
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GENDER *
BIRTHDAY *
MM
/
DD
/
YYYY
LEVELS (select one) *
PLEASE REGISTER IN THE GRADE YOU WILL BE IN SEPTEMBER 2018
School attending in September 2018 *
Your answer
Grade of participant in September 2018 *
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ALBERTA HEALTH CARE # *
Your answer
PARENT(S) *
Your answer
ADDRESS *
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PHONE(S) *
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EMERGENCY CONTACT (If different from above)
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EMAIL ADDRESS *
Your answer
METHOD OF PAYMENT *
CREDIT CARD # *
Your answer
EXPIRY DATE *
Your answer
NAME (as printed on credit card) *
Your answer
Additional Information (optional)
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