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Know of a Child Who Would
Be a Good Fit?
Fill Out the Form Below!
First Name
Last Name
Email
Phone
Please provide the names and ages of each child you would like to participate.
Please provide preliminary contact information (name, email, phone number, and physical address) of child's guardian(s).
Would you consider the referred child at-risk?
Yes
No
Please describe the circumstance or situation that you believe would classify the referred child as at-risk. Why do you believe that Camp Ezri would be beneficial to the child?
How did you hear about us?
Event
Web Search
Social Media
Other
Would you like your referral to remain anonymous?
Yes
No
Submit
Thanks! We'll be in touch with you soon.
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