____________________________________________________________________
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Camper Name
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____________________________________________________________________
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Parent/Guardian
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____________________________________________________________________
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Address
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____________________________________________________________________
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____________________________________________________________________
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Phone
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____________________________________________________________________
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Method of Payment:
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____Check : make payable to Brookhill Farm, Inc.
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____Mastercard/Visa
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____________________________________________________________________
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Credit Card # Exp. Date
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____________________________________________________________________
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Signature
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____________________________________________________________________
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Name as it appears of the card
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