| First Name (s): |
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| Last Name: |
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Birth Date: |
Month Day Year |
| Health Card Number |
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| Age |
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| Gender |
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| School Grade |
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| Name of School |
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| Complete Address: |
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| Street name and number: |
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| City: |
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| State: |
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| Postal Code: |
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| Telephone (House): |
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| Fax: |
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| E-mail (student): |
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| Parent’s names: |
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Parent’s telephone numbers: Home, office and cellular: |
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| Parent’s email: |
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| Please indicate any allergies the student may have |
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Level of Spanish:
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Program and dates for Participating:
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Week 1 July 7 - 11, 2008 choice of clinic + Spanish classes
Scuba Diving 1 Clinic
Golf Clinic
Sailing Clinic
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Week 3 July 21 – 25, 2008
Week 4 July 28 – August 1, 2008
Week 5 August 4 – 8, 2008 |
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Week 1 July 6 - 13, 2008 choice of clinic + Spanish classes
Scuba Diving 1 Clinic
Golf Clinic
Sailing Clinic
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Week 2 July 13 – 20, 2008 choice of clinic + Spanish classes
Theater Clinic
Scuba Diving 2 Clinic
Aviation Clinic
Horse Back Riding Clinic
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Week 3 July 20 – 27, 2008
Week 4 July 27 – August 3, 2008
Week 5 August 3 – 8, 2008 (note week 5 is shorter week is only $650 |
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Emergency contact numbers |
| Contact #1. |
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| Name |
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| Relationship whit the student: |
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| Telephone (s): |
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| Contact #2. |
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| Name |
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| Relationship whit the student: |
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| Telephone (s): |
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Parents and Students acknowledge receiving and understanding the following documents:
ACCEPT |
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