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Select Studio Location
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Select Camps
Hold CTRL button to choose more than one.
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Campers Name:
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D.O.B.
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Home Phone:
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Parents Name & Home Address: (for receipt mailing)
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Emergency Contact:
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Phone:
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Allergies/Medical Information: (List any and all) :
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Medical Permission Info: In case of an accident or serious illness, I request that the camp contact me. If they are unable to reach me, I authorize them to call the physician indicated below and follow his/her instructions. If it is impossible to contact the physician, the camp may make whatever arrangements necessary to expedite medical attention for my child.
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Parents Name:
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Date:
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Type "yes" to agree with the above
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Physician Name:
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Phone:
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Physician Address:
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I understand that my child will be released to his/her legal guardian only unless I inform the staff otherwise. Type "Yes" in the box to the right:
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Total Charges (One camp $95, two or more $85 each)
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Master Card or Visa Number:
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Exp Date:
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Name on Card:
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Card Mailing Address Zip Code:
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