The Braille Monitor                                                                                               April, 2002

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NFB CAMP PREREGISTRATION FORM

Completed form and fees must be received on or before June 15, 2002.

 

Parent's Name__________________________________________________

Address________________________________________________________

City ____________________ State ____ Zip _______ Phone ________

 

Child(ren)'s Name(s)

________________________________Date of Birth _________ Age ____

_______________________________ Date of Birth _________ Age ____

_______________________________ Date of Birth _________ Age ____

 

Include description of any disabilities/allergies we should know about:

_________________________________________________________________

_________________________________________________________________

 

Who, other than parents, is allowed to pick up your child?

_________________________________________________________________

 

Per Week: $80 first child; $60 siblings, # of children _____, $ ________

(Does not include banquet)

Per Day:$20 per child per day, # days ____ x $20/child$ ________

(Does not include banquet)

 

Banquet: $15 per child,   # of children _____ x $15 $ _______

Total Due $ ________

 

Make checks payable to and return forms to National Federation of the Blind of Oregon, 5005 Main Street, Springfield, Oregon 97478, (541) 726-6924

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