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Student First Name*required

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Current School*required

Grade in Fall*

7  8  9  10  11  12 

Date of Birth*required

Address*required

Add On*

Counseling  None 

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1 Week  2 Weeks  3 Weeks 

Boarding or Day Camp*

Boarding  Day 

Parent First Name*required

Parent Last Name*required

Parent Phone Number*required

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Parent Address*required

Emergency Contact Name*required

Emergency Contact Relationship*required

Emergency Contact Phone Number*required

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