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LLCA Kindergarten Camp Registration Form 2019
Free Kindergarten Camp July 31 - August 1, 2019 9 am-12 noon
Student must be five on or before August 31, 2019 in order to meet requirements for kindergarten.
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Email
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Your email
Students Name (last, first)
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Your answer
Date of Birth
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MM
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DD
/
YYYY
Parent/Guardian Name
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Your answer
Parent/Guardian Phone Number
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Your answer
Parent/Guardian Email Address
Your answer
Parent/Guardian Name
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Your answer
Parent/Guardian Phone Number
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Your answer
Parent/Guardian Email Address
Your answer
Address (Please include street number, street name, city and zip)
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Your answer
County of Residence
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Rutherford
Polk
Henderson
Buncombe
McDowell
Other
Medical Allergies
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Your answer
Medical Alerts
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Your answer
Current Medications
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Your answer
Emergency Contact 1 (other than parent)
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Your answer
Emergency Contact 1 Phone Number
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Your answer
Emergency Contact 2 (other than parent)
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Your answer
Emergency Contact 2 Phone Number
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Your answer
Emergency Contact 3 (other than parent)
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Emergency Contact 3 Phone Number
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Custody Issues?
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Yes
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Is your child enrolled for LLCA for 2019-2020?
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