CYC Summer Program Registration
Program registration for summer programming 2018
Email address *
Sailor's Name *
Your answer
Gender *
Sailors Birth Date *
MM
/
DD
/
YYYY
Summer Program you are registering for *
Referred by
Your answer
Session Registration
Please see our program below, and select the session your sailor would like to sail in. Please note more than one session may be registered for at one time (you do not need to fill out multiple registrations unless you are registering multiple sailors) More information and a confirmation will be emailed to you within 7 business days of your registration unless you are a non member. Non Members will be able to fill in program spaces as of March 19th.
STEM Program
Sea Squirts
Beginner Optimist
Intergreen Optimist
Beginner 420 (am only)
Intergreen 420 (pm only)
Fun Week (pm only)
Race Team
If choosing race team weekly please detail which weeks below
Your answer
Member/ Non-Member *
If Member please provide member number
Your answer
If non-member please provide sponsors name
Your answer
Sailors Weight
Your answer
Sailors Height
Your answer
Parent's Name *
Your answer
Address *
Your answer
Phone: Cell *
Your answer
Phone: Home
Your answer
Medical Information
Please list any allergies, medical conditions including those requiring maintenance medications (Diabetes, Asthma, Seizures etc)
Medical Information
Your answer
Emergency Contact Information
Please provide details below
Emergency Contact Name *
Your answer
Emergency Contact Number *
Your answer
Emergency Contact Relation to student *
Your answer
Insurance Information
Please provide us with insurance information below
Insurance carrier *
Your answer
Policy Number *
Your answer
Name of Policy Holder *
Your answer
Policy Holder's Contact Number (if different from above)
Your answer
Billing Information
Please provide how you would like to be billed for this program- please note if you are a non-member payment needs to be procured before your sailors first day of programming. If you choose to use a CC please note that a staff member will contact you for the card details.
Payment Method *
A copy of your responses will be emailed to the address you provided.
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