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First Name
Last Name
Date of Birth
Cell Number of camper (if she has)
Current grade
Current School
Current Teacher
Phone number of current Teacher
Best time to Reach The Teacher
Previous Schools
Teacher Last Year
Phone Number of Last Years Teacher
Previous camps attended
Mothers Name
Mothers Phone Number
Fathers Name
Fathers Phone Number
Email Address of Parent
Email Address of Camper (If She has)
Street Address
City
State
Zip-Code
Any allergies? Please list
Any medication? Please list
Who did you hear about us from? (Being specific will help speed up the application process)
Additional notes or comments
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