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2017 Emerson Family YMCA Summer Camp RegistrationChild's Name: Gender: Birthdate: / / Age: Primary Address: City: State: Zip: Child grade entering in fall: Parent/Guardian's #1 Name: Home Phone: Cell
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Child has a medical condition.
Parents or legal guardians are required to file.
You can fill out the form online or on paper.
The purpose is to provide information about the child's medical condition for medical and insurance purposes.
Information such as the child's name, date of birth, medical diagnosis, treatment plan, and contact information.
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