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| Camper's Name: * |
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| Camper's Nickname: |
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| Week(s) camper is attending |
6/20 - 6/26 Week One |
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6/27 - 7/03 Week Two |
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7/04 - 7/10 Week Three |
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7/11 - 7/17 Week Four |
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7/18 - 7/24 Week Five |
| Camper's date of birth: Month: * |
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| Day: * |
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| Year: * |
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| Age at camp: * |
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| Gender: |
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| Does camper live with both parents? |
Yes No |
| Who will have custody while the child is at camp? |
Mom Dad Either |
| Other: |
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| Mother's Name: * |
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| Father's Name: * |
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| Is child affected, or likely to be affected, by any custody orders while camp is in session? |
Yes No
(If yes, please contact the Camp Director and provide details) |
| Does your camper know how to swim? |
Yes No |
| Any physical limitations?: |
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| Does your camper have a preference for a cabin mate? |
No |
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Yes
(If yes, please list names by order of preference)
(Every attempt is made to grant cabin mate preferences, but cannot be guaranteed. Cabin mates must be of the same gender and within a year of the same age.) |
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