Middle School Fall Retreat 2017
TELL US ABOUT YOUR STUDENT
First & Last Name
Your answer
Campus
Required
Gender
Required
Grade
Required
Birth Date mm/dd/yyyy
Your answer
Who would your child like to share a cabin with?
Your answer
PARENT/GUARDIAN INFORMATION
Parent #1
Your answer
Email
Your answer
Phone Number(s)
Your answer
Parent #2
Your answer
Email
Your answer
Phone Number(s)
Your answer
EMERGENCY/MEDICAL
Emergency Contact
Please tell us who to contact if the Parent/Guardian listed above cannot be reached.
Your answer
Phone Number(s)
Your answer
Medical Conditions
Please let us know if there are any medical concerns that we need to be aware of, including dietary restrictions or allergies.
Your answer
Care Card Number
Your answer
Payment Method
Payment is due no later than October 3rd
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