2017 Summer Mini Camp Program
2017 Summer Mini Camp Application
Email address *
First Child's Full Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Does your child have any significant medical conditions or allergies? *
If Yes, please explain.
Your answer
Parent/Guardian's Name *
Your answer
Address *
Your answer
Phone Number (1) *
Your answer
Phone Number (2)
Your answer
Emergency Contact (Other than parent - we would always call a parent first) *
Your answer
Relation to Child (E.g Grandparent, Aunt, Uncle, Neighbor, Friend) *
Your answer
Emergency Contact Phone Number *
Your answer
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