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Child Information
Last Name *
First Name *
Date of Birth *
Health Card Number *
Allergy or Medical Information
Activities Select which ones your child will be included in	Camp Only                     Outing                     Extended Hours (3:00pm - 5:00pm)
Parent/Guardian Information
Last Name *
First Name *
Address * Street, City, State
City
Postal Code
Home Phone *
Cell Phone
Work
Email Address *
In Case of Emergency:
Full Name *
Phone *
Other Information
Authorized Person(s) who will pick up your child *
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