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Check Weeks Desired - $125.00 first week - $115.00 each additional week |
June 23 - June 27
June 30 - July 4
July 7 - July 11
July 14 - July 18
July 21 - July 25
July 28 - August 1
August 4 - August 8
August 11 - August 15
August 18 - August 22
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Is there anything physical, mental, or emotional about your child we should know?
Is there anything in particular you would like us to know about your child?
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Medical Information: Please bring a copy of child's up-to-date immunization record.
Date of Last Tetanus Shot: ____________________
Does child have: ____Heart Trouble ____Epilepsy ____Asthma ____Allergies
Does child take medications regularly? ____Yes ____No
If so, please list: _____________________________________________________________
Insurance Name:______________________________ Number:________________________
Doctor's Name: ____________________________ Telephone: __________________________
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Please complete and mail with your $25.00 non-refundable registration fee.
____Check/Money Order Enclosed ____MC/Visa #___________________ Ex Date__________
| Permission form will be mailed to you. |
We look forward to seeing you at camp! |