2019 IMAGINATION SUMMER TECH CAMP
Email address *
FIRST NAME *
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LAST NAME *
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OTHER NAMES
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NICK NAME
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SEX:
CONTACT ADDRESS: *
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PHONE NUMBER: *
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PARENT'S FACEBOOK:
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SCHOOL NAME:
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PARENTS PHONE NUMBERS: *
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T-SHIRT SIZE
DAILY HEALTHY FOOD/TREATS (1000)
LATE PICK - UP (AFTER 4:00 PM)
N1000 FOR EVERY HOUR
NUMBER OF WEEKS
SPECIAL NEEDS/LIMITATIONS/ALLERGY/NOTES
EXPLAIN IN THE SECTION:
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AUTHORIZED TO PICK UP CHILD
NAME
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PHONE NUMBER *
Your answer
NAME
Your answer
PHONE NUMBER
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