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Pasquaney’s 130th

Pasquaney’s 130th

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Prospective Camper Form

Required

Please fill out this form, and if you have any questions email office@pasquaney.org or call (603) 744-8043.

Prospective Camper Namerequired

First Name

Nickname (optional)

Last Name

Prospective Camper Date Of Birthrequired

Must contain a date in M/D/YYYY format

Parent/Guardian 1 Namerequired

First Name

Last Name

Parent/Guardian 1 Email Addressrequired

Parent/Guardian 1 Phone Numberrequired

Addressrequired

Street Address

City, State / Province / Regionrequired

Zip / Postal Coderequired

Countryrequired

Add Parent/Guardian 2 Information?

Parent/Guardian 2 Name

First Name

Last Name

Parent/Guardian 2 Email

Parent/Guardian 2 Phone Number

Same Address as Previous?

Parent/Guardian 2 Addressrequired

Street Address

City, State / Province / Regionrequired

Zip / Postal Coderequired

Countryrequired

I would like to be placed on the Prospect List for the Summer of

Must contain only numbers

Please contact me about the availability of financial aid for my son.

How did you hear about Pasquaney?