SUPER STAR SUMMER CAMP APPLICATION
Camper Information
Last Name *
First Name *
Middle Name
Nick Name
Date of Birth *
MM
/
DD
/
YYYY
Age *
Address Line 1 *
Address Line 2
City *
State *
Zip Code *
Has your child been identified with dyslexia?
Clear selection
Is your child adopted?
Clear selection
Is English your child's first language?
Clear selection
If not, what age did your child begin to speak English?
How did you hear about the "Every Child Reading" Super Star Camp Program?
Contact and Mailing Information
Every Child Reading
2017 Summer Camp Program

4EveryChildReading@gmail.org

Make checks payable to: Every Child Reading
Application fees and documents should be sent to:
Every Child Reading
7435 East Maple Ave, Denver, CO 80230
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