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2019 Tom Bass Camp Registration
June 17th – June 21st
Hours: 9:00am – 3:00pm @ Murphey Candler Park
* Indicates required question
Email
*
Your email
Camper's Name
*
Your answer
Camper's grade
*
Your answer
Camper's Age
*
Your answer
Home Phone
*
Your answer
Cell Phone
*
Your answer
Returning Camper?
*
Yes
No
Parent(s) Name(s)
*
Your answer
Parent(s) Email(s)
*
Your answer
Address
*
Your answer
Method of Payment
*
Link to use a credit card or PayPal
Mailing a check to: 4610 Hardwick Court, Suwanee, GA 30024
Any info we should know about your child
Your answer
Medical Insurance Carrier
*
Your answer
Medical Insurance Policy Number
*
Your answer
Are there any medical conditions that physicians should be aware of?
Your answer
Emergency Contact Name (other then parent)
*
Your answer
Emergency Contact Phone (other then parent)
*
Your answer
Parent's Signature
*
Your answer
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