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Journey Camp Registration
June 15 - 17th | Grades Entering K -5th
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* Indicates required question
Email
*
Your email
Student's First Name
*
nombre del estudiante
Your answer
Student's Last Name
*
Apellido del estudiante
Your answer
Student's Date of Birth
*
Fecha de nacimiento (mm / dd / aaaa)
MM
/
DD
/
YYYY
Student's Age
*
edad del niño
Your answer
Student's Grade Going into NEXT Year
*
Grado de la escuela del niño Entrando al PRÓXIMO año
Choose
K
1st
2nd
3rd
4th
5th
School
Your answer
Student's Gender
*
Male
Female
Parent's First Name
*
Nombre de los padres
Your answer
Parent's Last Name
*
Your answer
Home Address
*
Direccion de casa
Your answer
Location
*
Hidden Country
Brookshire Village
Other
Parent Phone Number
*
Número de teléfono celular de los padres
Your answer
Secondary Emergency Phone Number
Número de teléfono de emergencia secundario
Your answer
Emergency Contact Name
Your answer
Is Student bringing medications or have allergies of any kind?
*
¿El niño tiene alergias? Alimentos, Temporada u Otros? ¿Tiene alergias?
Yes
No
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