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David Adelman CAMP APPLICATION (Parents, please complete both sides)
Name___________________________________________ Address_________________________________________ City, State, Zip___________________,_______,__________ Age____Height_________ Weight__________ School ______________________________ Entering Grade___ Please note any medical conditions or allergies to medications. ___________________________________________________ Name of parent or guardian : ___________________________ Emergency phone #__________________________________ Signature of parent please complete next page David Adelman 161 E. Chicago Avenue #55C Chicago, IL 60611
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