Camp Leo Registration Form
Last Name
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First Name
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Gender
Parent/Guardian First and Last Name
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Relationship to Student
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Street
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City
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Zip Code
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Home Phone
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Work Phone
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Cell Phone
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e-mail
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Name of Emergency Contact
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Relationship to Student
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Contact Number
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Student e-mail (if applicable)
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Student Cell Phone (if applicable)
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Student Date of Birth
MM
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DD
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YYYY
Grade in 2015-2016 School Year
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School Attending in 2015-2016 School Year
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Please describe how your student will arrive and depart from class (walk, public transportation, carpool, parent/guardian)
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Please list any allergies we should be aware of
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Date of Submission *
MM
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DD
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YYYY
Please describe any medical/physical/behavioral or learning needs or issues that may impact your child's participation
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Other things we should know? Please describe
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Please describe your child's skill level and previous participation in performing arts.
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I hereby warrant that I am the parent or legal guardian of the above named Student and have full authority to execute this Registration Form and Release, which I have read, understand and approve. I hereby agree that both Student and I shall be bound to terms stated on this Registration Form and Release. *
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