Registration for Camp Izza

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Parent 1 Full Name
Parent 2 Full Name
Address
Address 2
City
State
Zip
Primary E-mail
Secondary E-mail


Phone Numbers (please complete at least two)
Phone Number 1
Phone Number 2
Phone Number 3
Phone Number 4


Emergency Contact 1 (someone other than parent/guardian who is authorized to pick up your child)
Name
Relationship
Phone



Emergency Contact 2 (someone other than parent/guardian who is authorized to pick up your child)
Name
Relationship
Phone