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KYC Junior Sailing Program Registration 2020
Parent First Name *
Last Name *
E-mail address
Relationship *
Cell phone *
Work phone
Home address *
City *
State *
Zip *
Student First Name *
Last Name *
Age *
Date of birth *
Gender *
Grade entering, fall 2020 *
Emergency Contact (Name) *
Phone *
Medical Doctor (Name) *
Phone *
Special Medical Conditions (including any allergies)
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