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Contact and Medical Info
Clinton Sailing Club
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Contact and Medical Info
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Sailor's First Name
*
First
Sailor's Last Name
*
Last
Guardian First Name
*
First
Guardian Last Name
*
Last
Email
*
Cell Phone
*
Please list a CELL PHONE so that we may text you in the event of weather emergencies, venue changes, etc. If we cannot text you, or it's a land line, please note this after your phone number.
Sailor's Age
*
Age as of June of this year
8
9
10
11
12
13
14
15
16
17
18
Pediatrician's Name and Phone Number
*
Allergies, special needs
Do NOT use pictures or video of my child to advertise for CSC
I do NOT consent for my child to appear in CSC promotional materials
For our program to be successful, we really need to publicize how much fun our sailors are having learning to sail. If this box is unchecked, your child might appear in photos/videos on our website or Facebook page.
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