PLSS Summer 2018 Registration
Please note that registration will not be considered complete until payment is received. Please see below for payment instructions.
Email address *
Contact Information
This information allows us to send important program information and contact the appropriate parties throughout the summer sailing season.
Sailor's Last Name *
Your answer
Sailor's First Name *
Your answer
Home Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Sailor's Age at Start of Program *
Your answer
Primary Phone Number *
Your answer
Mother/Guardian's Name *
Your answer
Mother/Guardian's Cell Phone Number *
Your answer
Father/Guardian's Name *
Your answer
Father/Guardian's Cell Phone Number *
Your answer
Secondary Email Address *
Your answer
Emergency Contact Name (Other than parent/guardian) *
Your answer
Emergency Contact Relationship *
Your answer
Emergency Contact Phone Number *
Your answer
In case of emergency, please contact ______ first. *
Next
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms