Lake Country Opti 2017 Registration
Email address *
Contact Information
Sailor Last Name *
Your answer
Sailor First Name *
Your answer
Sailor Home Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Sailor Date of Birth *
MM
/
DD
/
YYYY
Parent Cell Phone Number *
Your answer
Parent Email Address *
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Mother/Guardian's Name *
Your answer
Mother/Guardian's Cell Phone Number *
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Mother/Guardian's Email Address *
Your answer
Father/Guardian's Name *
Your answer
Father/Guardian's Cell Phone Number *
Your answer
Father/Guardian's Email Address *
Your answer
Emergency Contact Name (Other than Mother/Father) *
Your answer
Emergency Contact Relationship *
Your answer
Emergency Contact Phone Number *
Your answer
In case of emergency, please contact ______ first. *
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