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COE #_______________
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I. Family
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Male Parent/Guardian 1 Last NameMale Parent/Guardian 1 First Name
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Female Parent/Guardian 2 Last Namefemale Parent/Guardian 2 First Name
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Current Address:City: ZIP:State:Phone:
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IN
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County:Cabin #: Camp:Crew Leader/Employer:Residency Date:
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II. Children
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Last Name 1Last Name 2SuffixFirst NameMiddle NameSexDOB BD Verification CodeMB FlagRace / Ethnicity
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IN School of ResidenceSTN #GradeBirthplace (City, State, Country)
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Last Name 1Last Name 2SuffixFirst NameMiddle NameSexDOB BD Verification CodeMB FlagRace / Ethnicity
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IN School of ResidenceSTN #GradeBirthplace (City, State, Country)
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Last Name 1Last Name 2SuffixFirst NameMiddle NameSexDOB BD Verification CodeMB FlagRace / Ethnicity
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IN School of ResidenceSTN #GradeBirthplace (City, State, Country)
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Last Name 1Last Name 2SuffixFirst NameMiddle NameSexDOB BD Verification CodeMB FlagRace / Ethnicity
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IN School of ResidenceSTN #GradeBirthplace (City, State, Country)
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Last Name 1Last Name 2SuffixFirst NameMiddle NameSexDOB BD Verification CodeMB FlagRace / Ethnicity
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IN School of ResidenceSTN #GradeBirthplace (City, State, Country)
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Last Name 1Last Name 2SuffixFirst NameMiddle NameSexDOB BD Verification CodeMB FlagRace / Ethnicity
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IN School of ResidenceSTN #GradeBirthplace (City, State, Country)
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