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2024 NorthRidge Middle School Camp
Dates: July 6-10, 2024
Location: Wheat State Retreat Center (11105 SW 86th St, Agusta, KS 67010)
More Info: Trae Snyder (785-285-0406) or Andrew Kastendick (913-904-2400)
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Student's First Name
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Student's Last Name
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Your answer
Student's Age
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Student Sex
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Male
Female
Grade Just Completed
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5th
6th
7th
8th
Church Affiliation
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NorthRidge Falls City
NorthRidge Humboldt
NorthRidge Peru
NorthRidge Sabetha
NorthRidge Seneca
Other:
Payment Choice
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$225 Early Bird Check or Cash (through 6/1/24)
Request Scholarship (talk to Trae or Andrew)
Home Address
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Preferred Phone Number
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Emergency Contact Name
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Emergency Contact Number
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Same as above
Other:
Family Doctor
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Family Doctor Phone Number
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Does your student have any special physical or emotional concerns or problems that we should be aware of? (If yes, please describe)
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