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Empowering Transgender Youth/Gender-Diverse & Youth Affected by HIV/AIDS
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Camper Application 2018
Please fill out the following fields:
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Camper Name
Birthdate *
Parent/Legal Guardian *
Home Address *
Phone Number *
Cell Phone
Work Number
Emergency Contact *
Emergency Contact Phone *
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Unnamed
Has your Child seen/Consulted with a social worker, psychologist and/psychiatrist in the last 6 months? *
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Unnamed
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5
Confirmation
Camper Name
Birthdate
Home Address
Phone Number
Emergency Contact
Parent/Legal Guardian
Cell Phone
Unnamed
Has your Child seen/Consulted with a social worker, psychologist and/psychiatrist in the last 6 months?
Work Number
Unnamed
Unnamed
Unnamed
Emergency Contact Phone
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