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Please
return this portion of the form with cheque at: Panthers
Gymnastics,
Half Day Camp: 9:00AM-12:00_______ Full Day Camp: 9:00-4:30 PM: _______
Gymnast’s name:________________________________ Birth date:(mm/dd/yyyy) ___________________
Address:
Parent’s name: Mother:______________________________
Father:______________________________
Parent’s Signature:____________________________________________________________________
Phone # :
_______________________________(home)
_______________________________ (work)
Cell:
_________________________________
_______________________________( )
e-mail Address:
______________________________________________________________________
Mb. Child Health #:
_____________________________________ Registration #: __________________
Known medical conditions:
_____________________________________________________________
Emergency contact:
_________________________________ Phone: ____________________________
Early drop off or Late Pick up @ $3.00 per
quarter hour. (please specify
times & days)______________
___________________________________________________________________________________