World Changers Academy Summer Camp Registration Form 
Please note: a non-refundable fee of $50 will be due within 48hrs of completing this form to hold your child's spot. 
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Child(ren)'s name(s) (first, last). Gender. Birth date(s) (MM/DD/YYYY). *
Address. (Street address, city, state, zip code) *
Any allergies, chronic illnesses, or medical conditions? If yes, please describe. If no, please respond no. *
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