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FUNdamentals in Nature Camp/Program Intake Form
Thank you for completing this intake form to help me get to know your child better!
-Alycia, Occupational Therapist at FUNdamentals in Nature OT Services
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Do you give permission to communicate via email regarding your child?
*
No I do not give permission for email communication.
Yes I give permission for email communication.
Do you give permission to communicate via text message or phone call should something come up during camp?
*
Yes
No
Child's First and Last Name, Nickname if applicable
Your answer
Parent/Caregiver name(s)
*
Your answer
Parent Email
Your answer
Parent Phone Number
Your answer
Preferred contact method
Text
Call
Email
Address
Your answer
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