Health Career Camp Application
Select preferred camp date
Camper Information
First Name:
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Last Name:
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Home Address:
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City:
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State:
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Zip:
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County:
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Birthdate:
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DD
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Phone:
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E-mail Address:
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Parent and/or Legal Guardian Information
Name:
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Phone:
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Relationship to camper:
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Name:
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Phone:
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Relationship to camper:
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Education Information
High School Name:
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High School Graduation Year:
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High School GPA to date:
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Name of Guidance Counselor:
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Phone:
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ACT Score:
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Other information
How did you hear about Health Career Camp?
What area of health care are you interested in?
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