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Application for Summer 2010 continued)

parent or legal guardian should complete this form.

Date of application

____________________________

Returning student

_____

New applicant

_____

Applicant’s full name

_________________________________________________________________________________________

first

middle

last

Age as of June 1, 2010 ___________

Date of Birth

__________________________________________

Preferred first name/nickname

_____________________________________________________

T-shirt size: S M L XL

Youth Adult

_____

_____

Home address

_______________________________________________________________________________________________

City __________________________________

State/Province

_______

Zip ________________

With whom does the applicant reside?

______________________________________________

Person responsible for camp fees: __________________________________________________

(Billing address if different from the applicant’s)

_ ____________________________________________________________________________________________________________

Parent/ Guardian’s Name(s) ____________________________________________________________________________________

Address _____________________________________________________________________________________________________

Home phone

__________________________

Fax

_____________________________

Cellular

_____________________________

Work phone

Work address ________________________________________________________________________________________________

Primary email address ____________________________________________________________

How did you learn about us?

___________________________________________________________________________________

EMERGENCY CoNTACTS

relationship to camper

telephone numbers

relationship to camper

telephone numbers

name

name

  • *

    Registration is complete when all fees are paid, health/medical and emergency forms are submitted.

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