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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