CMT Aussie Kids Camp 2021
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Child's Name *
Parent's Names *
Child's Date of Birth (mm, dd, yyyy) *
MM
/
DD
/
YYYY
Email *
Postal Address *
Phone number (Landline) *
Phone number (Mobile) *
Type of CMT (if known)
Any other family members with CMT? *
Do you/ your child have any mobility aids? *
Any additional comments?
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