2012 SUMMER YOUTH CAMP

REGISTRATION FORM

LAST NAME

FIRST NAME

NICKAME
AGE
M

BIRTHDATE ( DD/MM/YYYY)
F

CONTACT NUMBER(S):

STREET ADDRESS (snail mail address)

EMAIL ADDRESS

OCCUPATION

SCHOOL : ___________________________________________
________________________________

THIS IS MY
_____________ TIME TO
ATTEND THE YOUTH
SUMMER CAMP
WHAT DO I EXPECT TO
HAPPEN IN THIS CAMP?

YEAR LEVEL/COURSE

Have any allergies? What are they?
_______________________________
_________________________________________
Will you be bringing medications? What are they
for? ___________

---------------------------------------

____________________________________________
___________________

---------------------------------------

In case of emergency, we will contact

__________________________

Name:
____________________________________________
__________

__________________________
__________________________

SEC CNC01-____

Contact number:
____________________________________________

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