Child's Name _____________________________________ ? Age ______
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| Parent(s) ______________________________________ ? Member? ? Y ? N |
Address ______________________________________
______________________________________________ |
| Phone _______________________ ? Email _________________________ |
| Summer Camp Selection _________________________________________ |
After care? ? Y ? N ? ? Allergies? _________________________________
___________________________________________________________ |
Check enclosed ______________
Credit Card # ________________________________________________
(Please circle type) ? Visa ? MC ? Amex ? Disc
Exp Date _________________________ |
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