February Vacation Camp
February 21 - February 25, 2022
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TRANSLATE THIS FORM: Español, Português, Tiếng Việt, Tagalog, Kreyòl ayisyen
FOR WHOM?
I AM A PARENT OR GUARDIAN
REGISTERING A NEW CHILD/MINOR TO PARTICIPATE
I AM A RETURNING PARENT OR GUARDIAN:
OUR FAMILY or HOUSEHOLD HAS REGISTERED FOR OTHER PROGRAM ACTIVITIES WITHIN THE PAST 3 YEARS
YOUR (PARENT/GUARDIAN) NAME:
YOUR (PARENT/GUARDIAN) CONTACT INFORMATION:
NAME:
(not parent)
CONTACT INFORMATION:
(OPTIONAL)
BIRTHDATE:
Please enter a valid birthdate here...
GENDER:
Please enter a gender information here...
use button or write in anything!
Male
Female
Non-Binary
PRONOUNS:
use button or write in anything!
He/Him/His
She/Her/Hers
They/Them/Theirs
LANGUAGE:
(only if not English)
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HOUSEHOLD/FAMILY DETAILS:
PARTICIPANT MAILING ADDRESS:
* ONLY IF OUTSIDE OF USA
YOU MAY ENTER ONE OR TWO RELATED ADULTS
WHO LIVE or WORK AT THIS ADDRESS:
ADULT #1
(optional)
parent, step-parent, guardian, spouse, etc.
(optional)
ADULT #2
(optional)
parent, step-parent,
guardian, spouse, etc.
(optional)
I WANT TO INCLUDE ANOTHER ADULT/PARENT/GUARDIAN AT A DIFFERENT ADDRESS
OTHER ADULT
(optional)
parent, step-parent, guardian, spouse, etc.
(optional)
OTHER MAILING ADDRESS:
* ONLY IF OUTSIDE OF USA
SUBMIT ADULT CONTACT INFORMATION
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PERSONAL INTRODUCTION
TELL US ABOUT YOURSELF:
TELL US ABOUT YOUR CHILD:
What specifically interests you in this program?
What other interests / hobbies / activities do you enjoy?
What specifically interests your child in this program?
What other interests / hobbies / activities do they currently enjoy?
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ALMOST DONE, KEEP GOING!
PLEASE COMPLETE THIS VALIDATION:
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