YLI Summer Leadership Camp
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Child's Full Name *
Age *
Gender *
Grade *
School *
Race and Ethnicity *
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Parent/Guardian's Full Name *
Relationship to Child *
Contact Number *
Child's Email *
Adult Email *
Home Address *
Emergency Contact Name *
Emergency Contact Number *
Alternate Emergency Contact Name *
Alternate Emergency Contact Number *
Any Allergies *
Any Medical Conditions *
T-Shirt Size *
Is there anything else we should know about your child? *
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