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Camper Medical Form
Camp Dates: July 24 - July 29 @ Lodestar, Wilseyville, CA
To ensure the safety of staff and campers, please carefully provide the medical background information of your youth.
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* Indicates required question
Camper Name (First, Last)
*
Your answer
Camper DOB
*
MM
/
DD
/
YYYY
Home Address (Address, City, State, Zip)
*
Your answer
Parent/Guardian Name
*
Your answer
Parent/Guardian Phone #
*
Your answer
Parent/Guardian Email
*
Your answer
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