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FULL NAME OF PARTICIPANT *

PHONE NUMBER *

EMAIL *

DATE OF BIRTH OF PARTICIPANT (mm/dd/yyyy) *

PARTICIPANT ADDRESS *

HEALTH ISSUES (if any we should be aware of) *

ENROLMENT FOR (select one) *

PA Day Camp Summer Camp Multiple Camps

CAMP DATE(S) *

CAMP FOR *

Son Daughter Other

COMMENTS (optional) *

HOW DID YOU HEAR ABOUT US? *

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40 Colonnade Road 613-852-3520 info@capitaltaekwondo.ca

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