Name *

Person Completing this form

First Name

Last Name

Contact Name

First Name

Last Name

Address *

Address of School, Daycare, etc

Address 1

Address 2

City

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Zip/Postal Code

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Age of Kids *

3 - 5 (PreK3 - PreK5)

6 - 8 (Kindergarten - 2nd)

9 - 11 (3rd - 5th Grade)

12 - 13 (6th-8th)

Date of Camp #1 *

Desired date of camp (not guaranteed)

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DD

YYYY

Date of Camp #2 *

Desired date of camp (not guaranteed)

MM

DD

YYYY

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