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Elderberry Blossoms - 2019-20 Sign-up Form
Youth Nature Immersion - Signup Form
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* Indicates required question
How many children would you like to enroll in camp?
*
Your answer
What is your child's first and last name
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Please list names if enrolling more than one child
Your answer
How old is your child?
*
(At time of camp)
Your answer
Your First Name
*
Your answer
Your Last Name
Your answer
What is your emergency contact number?
*
Your answer
What is your email address?
Your answer
Does your child have any allergies?
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If yes, please list.
Your answer
What is the name of your child's health care provider/doctor and the number they can be reached at?
*
Your answer
What is your child's medical ID #?
*
Your answer
How did you hear about Elderberry Blossoms?
Your answer
What is your address?
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Your answer
What is your phone number?
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Your answer
Does your child have any medical conditions that camp staff should be aware of?
Your answer
Does your child know how to swim?
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If yes, at what level?
Your answer
We look forward to spending an amazing time with your child in the Petaluma River Watershed. Is there anything you can tell us about your child that will help improve their experience?
Your answer
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