Camp LUCKY 2017 Registration Form
Please complete all sections of this form. Registration is not final until payment is received.
Email address *
Accurate Speech Inc.
Camper Full Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Address *
Your answer
Parent or Guardian Name *
Your answer
Address *
Your answer
Phone number *
Your answer
Emergency Contact *
Your answer
Please list all allergies: *
Your answer
Special instructions: *
Your answer
Name and number of pediatrician. *
Your answer
Please mark the camp name and session your child will be attending. *
Required
Please call 440-895-1309 or email us at accuratespeech@gmail.com for more information.
20800 Westgate Mall, Suite 510 Fairview Park, OH 44126
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