EdVenture Camp Student Registration 2017
Student Name *
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Current Grade *
Parent/Guardian Name *
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Phone Number- Home/Cell *
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Email Address *
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Work Phone Number *
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Emergency Contact Name *
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Emergency Contact Relationship *
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Emergency Contact Phone Number *
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Known Allergies *
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Daily Medication *
Name of Medication *
Your answer
Transportation *
Bus "pick up/drop off" address *
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Permissions *
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Signature *
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Date *
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