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Household Information

* Today's Date
* Household Last Name
* 5 Town Resident? (Bristol, Lincoln, Monkton, New haven, Starksboro)
* Email Address
Primary Household Person
* Name
* Address
* Home Phone
* Work Phone
* Cell Phone
* Gender
* Birthdate
* Allergies
* Medications/Medical Condition
* Special Accomodations
Secondary Household Person
* Name
* Address
* Home Phone
* Work Phone
* Cell Phone
* Gender
* Birthdate
* Allergies
* Medications/Medical Condition
* Special Accomodations
Emergency Contact Information (someone other than spouse or parents, in case they cannot be reached)
* Name
* Address
* Home Phone
* Work Phone
* Cell Phone
* Relationship
* Would you like to subscribe to our monthly E-Rec newsletter?
Email address to send it to
* Would you like to receive a free lunch if one is available for the class/camp you are registering for?