Child 1:

First Name:

Last Name:

Age: —Please choose an option—89101112

Diploma: —Please choose an option—CDEF

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Child 2: (Optional)

First Name:

Last Name:

Age: —Please choose an option—89101112

Diploma: —Please choose an option—CDEF

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Parent / Guardian:

First Name:

Last Name:

Address:

Contact Number:

E-mail:

I have read, understand, and accept the Camp Disclaimer and Waiver