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Please fill out all the information below:

Camp Date

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Child's Information

Child's Name
MM slash DD slash YYYY
Address(Required)
Mother's Information

Father's Information

Additional Information

Individuals other than Parents Authorization

ONLY these individuals have my authorization to care for my child in the event of an emergency and/or for drop-off and pick-up. Please advise these individuals that they are authorized and will need to present identification at pick-up.