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* 1. Name (First and Last)

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* 2. Age

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* 3. Contact Email (Parent/Guardian Preferred)

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* 4. Dietary Restrictions

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* 5. Is there any other medical information we need to know at this time?

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* 6. Health Card Number

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* 7. Emergency Contact Name

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* 8. Emergency Contact Phone Number

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* 9. The Cost for this retreat is $50. Would you require assistance in covering this fee?

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* 10. We would take everyone off-site to complete a hike as a part of the retreat. Would you consent to us transporting your child to partake in this activity?

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