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* 1. Camper Name

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* 2. Date of Birth

Date

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* 3. Parent Name

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* 4. Primary Contact Number

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* 5. Address

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* 6. Emergency Contact #1

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* 7. Emergency Contact #2

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* 8. Approved Pick Up Individuals (ID Cards for these individuals must be on file)

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* 9. Allergies or Medical Conditions (If medication is needed, please provide medication information)

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* 10. Please check your camp package

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