CED 172- 90 Health Care Camp

July 8th, 9:00 am-3:00 pm
Parent's Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail*
Child's Name*

First NameLast Name
Child's Birth Date*

MonthDayYear
Grade that camper will be enrolled in 2019-2020 *
I have been a resident of Maine since: (Note: answer does not exclude you from participating)*
Please let us know if there is anything specific we should know about working with your child
How did you hear about this camp?*

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July 8th, 9:00 am-3:00 pm