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Game Time Gym Summer Camp 2017
Email address
Name of Camper
Grade Fall 2017
Home Phone
Cell Phone
Work Phone
Address
City
Zip
Email
Mom's Name
Dad's Name
Participation Time
If Part Time, which days of the week or Please List out the days that you are registering for the whole summer
Extended Hours
If you answered YES for Extended Hours: All Dates? Which Dates?
First Day of Attendance?
MM
/
DD
/
YYYY
Last Week of Attendance
MM
/
DD
/
YYYY
Waiver Acknowledgement:
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