LLCA-CFA Kindergarten Camp Registration Form
Free Kindergarten Camp July 31 - August 2, 2018 9am-12 noon
Students Name (last, first) *
Your answer
Date of Birth *
MM
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DD
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YYYY
Parent/Guardian Name *
Your answer
Parent/Guardian Phone Number *
Your answer
Parent/Guardian Email Address
Your answer
Parent/Guardian Name *
Your answer
Parent/Guardian Phone Number *
Your answer
Parent/Guardian Email Address
Your answer
Address *
Your answer
County of Residence *
Medical Allergies *
Your answer
Medical Alerts *
Your answer
Current Medications *
Your answer
Emergency Contact 1 (other than parent) *
Your answer
Emergency Contact 1 Phone Number *
Your answer
Emergency Contact 2 (other than parent) *
Your answer
Emergency Contact 2 Phone Number *
Your answer
Emergency Contact 3 (other than parent) *
Your answer
Emergency Contact 3 Phone Number *
Your answer
Custody Issues? *
Is your child enrolled for LLCA-CFA for 2018-2019? *
Would you like more information about LLCA-CFA? *
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