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Family Camp Registration Form 2017

August 4-6, 2017

Please make sure you include yourself, the kidney kids, additional adult and any additional kids in your total
Camper Information
Please list every member of the family who will be attending camp. Make sure to remember yourself and any other caregivers!
Primary Caregiver
*

Please provide a cell phone. This number is given to your child's camp counselor at Camp.
*

First Name
Last Name


First Name
Last Name

*

First Name
Last Name
Age/Grade Entering In Fall 2017
*

(mm/dd/yyyy)
*

*

Date of Kidney Transplant

Other reason qualify for Camp

First Name
Last Name
Age/Grade Entering In Fall 2017

First Name
Last Name
Age/Grade Entering In Fall 2017

First Name
Last Name
Age/Grade Entering In Fall 2017

*


Camp Shirts
Please list your shirt sizes for each member attending camp. Please only list one shirt for each member. We have sizes from Youth XS to Adult 3XL.

Camp Goals