Thomas Dunn Learning Center Free Summer Camp - 3113 Gasconade
Please complete this form completely for each child you intend to register for a camp offering.
What camp(s) are you signing your child up to attend? *
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Child's First Name *
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Child's Last Name *
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Child's Gender *
Child's School *
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Child's Address *
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Child's Zip Code *
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City Resident
Child's Medical Concerns (anything we should know?) *
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Guardian's First Name *
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Guardian's Last Name *
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Guardian's Phone Number *
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Guardian's Email Address (for confirmation and camp updates) *
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Second Contact First Name
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Second Contact Last Name
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Second Contact Phone Number
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Second Contact Email Address ( for confirmation and camp updates)
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Second Contact Email Address (confirmation and camp updates)
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I hereby authorize the designated camp staff to act for me, according to their best judgment, in the event of an emergency requiring medical attention. The above name applicant is in good health and has my permission to participate in the selected camp (s). In case of emergency, I grant permission for my child to be given emergency treatment. I hereby release the designated camp staff from all liability for any injury or illness incurred at camp or in the transportation to and from the camp for treatment of said injury or illness. *
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