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KYC Junior Sailing Program Registration 2018
Parent First Name *
Your answer
Last Name *
Your answer
E-mail address
Your answer
Relationship *
Cell phone *
Your answer
Work phone
Your answer
Home address *
Your answer
City *
Your answer
State *
Zip *
Your answer
Student First Name *
Your answer
Last Name *
Your answer
Age *
Your answer
Date of birth *
Your answer
Gender *
Grade entering, fall 2018 *
Emergency Contact (Name) *
Your answer
Phone *
Your answer
Medical Doctor (Name) *
Your answer
Phone *
Your answer
Special Medical Conditions (including any allergies)
Your answer
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