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Camper Chosen Name
Camper Gender Identity
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Camper Preferred Pronouns
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Race
Black or African American
Native American or Alaska Native
Asian
Native Hawaiian or other Pacific Islander
White or Caucasian
Date of Birth
Contact Phone
Home Address
Will any family member(s) be joining you for the retreat? If yes, please add their chosen names AND ages below.
Family Member Gender Identity
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Family Member Gender Identity
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Family Member Preferred Pronouns
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Family Member Preferred Pronouns
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Family member(s) relationship to camper:
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