June 29th through August 26th, 2021
Tuesdays & Thursdays
11:30 am - 1:30 pm

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* Please answer all questions:

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* Preferred method of contact?

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* How many children will be attending our program this summer?

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* My child/children: (Check all that apply.)

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* Pediatrician's Name:

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* Child #1

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* Child #2

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* Child #3

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* Child #4

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* Child #5

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* Child #6

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* Child #7

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* Child #8

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