CHS-MC Family Camp Registration
Luther Village July 10-15, 2022
Adult 1
First Name
Last Name
Relationship to the child with a bleeding disorder.
Please Select
Parent
Guardian
Caregiver
Grandparent
Live with child's parent
Family Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Adult 2
First Name
Last Name
Relationship to the child with a bleeding disorder.
Please Select
Parent
Guardian
Caregiver
Grandparent
Live with child's parent
Child 1
First Name
Last Name
Child 1 Age
Child 1 Bleeding Disorder
Child 2
Child 2
First Name
Last Name
Child 2 Age
Child 2 Bleeding Disorder
Child 3
Child 3
First Name
Last Name
Child 3 Age
Child 3 Bleeding Disorder
Child 4
Child 4
First Name
Last Name
Child 4 Age
Child 4 Bleeding Disorder
Child 5
Child 5
First Name
Last Name
Child 5 Name
Child 5 Age
Child 5 Bleeding Disorder
Child 6
Child 6
First Name
Last Name
Child 6 Age
Child 6 Bleeding Disorder
If there are more than 6 children, please list the remaining kids here with their name, age and bleeding disorder.
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