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Child's First Name:
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Child's Last Name:
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Date of Birth:
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Grade Entering for 2010-2011 School Year:
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Child's Gender:
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Female
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Male
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July 5-9, 2010 Girls In Science 9am-5pm
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Session 1
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July 12-16, 2010 Experiment Extravaganza
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Session 2
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July 19-23, 2010 Robotics for Beginners
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Session 3
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July 26-30, 2010 Robotics-Intermediate
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Session 4
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July 26-30, 2010 Book Club and Writers Rock
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Session 5
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Parent's Last Name:
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Parent's First Name:
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Parent's Address (Street Number and Name):
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Parent's City, State, Zip Code:
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Phone Number:
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Phone Number (Cell):
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Phone Number (Cell #2):
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Email Address:
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Email address (2):
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Additional Contact Information:
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Additional Contact Person's Name/Phone Number:
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Additional Contact Person's Relationship to Child:
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Pertinent Medical Information-Food Allergies(allergies/disabilities, etc):
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