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st. andrew's summer camps: registration [camps]

First Name:

Last Name:

Email Address:

Nickname:

Suffix (Jr, III, etc):

Birth Date (MM/DD/YYYY):

/ /

Gender:

Home Phone:

Street Address:

City:

State:

Zip Code:

School Name:

Years Experienced:

Age Group:

3-5
6-7
8-9
10-11
12-13
14-18

Position:

Camp Session:
Cost: $225

Emergency Contact:

Emergency Contact Phone:

Medical Conditions/Problems:

Participant Primary Medical
Insurance Carrier or None:

Policy Number or None:

Name of Policy Holder or None:

I agree to the above terms

 

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