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Yes! I would like my child to attend Camp Catch Your Breath.

Please complete the following information and return. Registration materials will be sent to you.

Parent/Guardian's Name_________________________________________________________

Address______________________________________________________________________

_____________________________________________________________________________

Telephone Number Daytime________________________Evening________________________

Child's Name____________________________________Age_____Birthdate_________Sex___

Mail to:

American Lung Association of West Virginia, P.O. Box 3980, Charleston,WV 25339-3980

Attn: Chantal Centofanti-Fields

Remember, the deadline for application is early July. Attendance is limited to 70 children.