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Queens to be Camp Registration Form
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Mailadresse
*
Din mailadresse
Untitled Title
Who is filling out this form?
A Parent or Guardian
A School Counselor
A sibling
The child applying for the program
Andet:
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First Name
Dit svar
Last Name
Dit svar
Age
Dit svar
Date of Birth
DD
/
MM
/
ÅÅÅÅ
School
Dit svar
Allergies or Limitations
Dit svar
Primary Address
Dit svar
Parent 1: First Name
Dit svar
Parent 1: Last Name
Dit svar
Parent 1: Cell Number
Dit svar
Parent 1: Work Number
Dit svar
Parent 1: Email
Dit svar
Parent 2: First Name
Dit svar
Parent 2: Last Name
Dit svar
Parent 2: Cell Number
Dit svar
Parent 2: Work Number
Dit svar
Parent 2: Email
Dit svar
Emergency Contact: First Name
Dit svar
Emergency Contact: Last Name
Dit svar
Emergency Contact: Phone Number
Dit svar
Emergency Contact: Email
Dit svar
Emergency Contact: Relationship to Child
Dit svar
Are you registering siblings?
Yes
No
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How do you plan to pay tuition?
Check
Electronically (Zelle, Venmo, Cashapp)
Cash
Andet:
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Question or Comments
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Denne formular blev oprettet inden for Deja Croft LLC.
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