Hospice
of the Valley - Camp Little Light of Mine |
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| Camper's Last Name | First Name |
| Home Address | |
| City State Zip | |
| Date of Birth / / Camper's Age Grade | |
| Sex | |
| Camp that you wish to attend | |
| Parent/Guardian's Name | |
| Parent/Guardian's Address | |
| City State Zip | |
| Daytime Phone () | |
| Evening Phone ( ) | |
| Relation of Person who Died | |
| For the protection of your privacy, this form will not submit
over the internet. Please print this form and mail it to: Hospice of the Valley, Inc. At day camp, the camper is involved in activities from 8:00 AM to 5:00 PM for the three days. There is no overnight stay. At weekend camp, the camper is dropped off Friday evening between 6-8 PM and is picked up on Sunday at 3:00 pm. |
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