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Parent/Legal Guardian First Name Signature of Parent/Legal Gaurdian Date mm/dd/yyyy 100 DEPOSIT PAYMENT MUST BE RECEIVED NO LATER THAN APRIL 15 2013. Ukrainian Youth Association Werchowyna Camp Registration 2011 CAMPER I N F O R M AT I O N Child s First Name IN ENGLISH Last Name Date of Birth mm/dd/yyyy Street Address City Province/State Postal/Zip Code Country CYM Branch Sex Grade Completed Home Phone Work Phone Emergency Contact/Phone Parent s e-mail Speaks Ukrainian T-Shirt Size CAMP Age...
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