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	Contact Information     Father First Name Last Name Mother First Name Last Name Street 1 Street 2 City State Zip Country Phone (w/ area code) Additional Phone Email Address (ie. bestmommy@aol.com) We are interested in...     the upcoming summer   the following summer How did you hear about Coleman Country? Please enter 32106 into the following box to confirm your form submission. Attending Children   1. Name Age Birthdate Grade (for Fall 2008)   Interests/Needs Previous Camping Experience 2. Name Age Birthdate Grade (for Fall 2008)   Interests/Needs Previous Camping Experience 3. Name Age Birthdate Grade (for Fall 2008)   Interests/Needs Previous Camping Experience 4. Name Age Birthdate Grade (for Fall 2008)   Interests/Needs Previous Camping Experience

P.O. BOX 34, Merrick, NY 11566 • 516.620.4300 • Fax: 516.620.4329 •
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