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2019 Opti Camp Registration
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* Indicates required question
Email
*
Your email
Sailor's First Name
*
Your answer
Sailor's Last Name
*
Your answer
Sailor's Date Of Birth
*
MM
/
DD
/
YYYY
Sailor's Gender
*
Female
Male
2019-20 School Grade
*
Your answer
Sailor's Home Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zip Code
*
Your answer
Mother's Name (Parent 1)
*
Your answer
Mother's Cell Phone Number
*
Your answer
Mother's Email
*
Your answer
Father's Name (Parent 2)
*
Your answer
Father's Cell Phone Number
*
Your answer
Father's Email
*
Your answer
Emergency Contact Name
*
Your answer
Relation To Sailor
*
Your answer
Cell Phone Number
*
Your answer
T-shirt Size
*
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Other:
LYC Membership
*
Member: Sailor is a child or a grandchild of a member
Non-Member: Sailor is a child of a non-member
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