LYC 2017 Seahorse and Opti Camp Registration
Email address
Sailor's First Name
Your answer
Sailor's Last Name
Your answer
Sailor's Date Of Birth
MM
/
DD
/
YYYY
Sailor's Gender
2017-18 School Grade
Your answer
Sailor's Home Address
Your answer
City
Your answer
State
Your answer
Zip Code
Your answer
Sailor's Summer Address (if different from home)
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
Camp Selection
T-shirt Size
LYC Membership
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