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Leslie Science & Nature Center 2015 DAY CAMP EMERGENCY×HEALTH×PERMISSIONS Dates and Name of Camp attending (list all) Camper Name (Last) (First) DOB Gender Grade completed in June 2015 Home Address

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Dates and name of refer to the specific dates and names that need to be reported or recorded.

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The information that must be reported on dates and name of includes specific dates and names associated with the event or activity.

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