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APPLICATION TO ATTEND CAMP KITAKI Please Print Name of Child Sex M F Birth date Age at time of Camp Address City State NE Zip Parents Name s Home Phone Work or Cell Phone County of Residence 1. Size of Family 2. Estimated Family Gross Annual Income 3. Single Parent Household Two Parent Household 4. Has this child ever attended camp before Yes No 5. If yes which camp s and when 6. If yes was it through this program Yes No* 7. Are you applying to attend Camp Kitaki this summer through another...

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