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/Day/Year Middle Female Birth Date Last Age at camp: Grade Sep 2011: Month/Day/Year Mail this form to the address below by May 15: CEDAR LAKE CAMP 21 Plymouth Street Fairfield, NJ 07004 1) Parent/Guardian should complete CAMPER HEALTH HISTORY (pages 1, 2, 3) and make a COPY 2) Send the signed form (pages 1,2,3) to the camp office ASAP -- no later than May 15. 3) Complete the top of CAMPER HEALTH-CARE RECOMMENDATIONs (page 4) and provide the copy of pages 1,2.

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