Child Information

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* 1. First Name

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* 2. Last Name

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* 3. Preferred Name

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* 4. Age

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* 5. Birth Date (MM/DD/YYY)

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* 6. Participant Age Requirement

Camps are designed to meet the needs of specific age groups. Campers must meet age requirements for each camp. This requirement ensures that instructors and staff can provide appropriate care and activities for each participant. Please share the name of the school where they are enrolled and the grade level completed in the 2023-2024 school year. Please share the name of the school where they are enrolled and the grade level completed in the 2023-2024 school year.

By indicating yes below, I confirm that the camper meets the age requirement of the camp for which they are applying for.

I understand and agree to the age requirements.

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* 7. Camper’s 2023-2024 School Name and Grade Level:

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* 8. Allergies

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* 9. If yes, please describe:

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* 10. Medical Conditions:

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* 11. If yes, please describe accommodations needed:

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* 12. How do you feel like this student will work in a collaborative setting? Please describe:

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* 13. Hospital Preference:

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* 14. Treating Physician name:

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* 15. Treating Physician number:

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