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Seawanhaka Corinthian Yacht Club
2017 SCYC Member Registration
NON-MEMBER APPLICATIONS WILL BE AVAILABLE MARCH 6, 2017 AT WWW.SEAWANHAKA.ORG/JUNIORCLUB
Seawanhaka Corinthian Junior Yacht Club
314 Yacht Club Road
Oyster Bay, NY 11771
Phone: (516) 922-6200 ext.117
juniorclub@seawanhaka.org
www.seawanhaka.org
Sailor's Information
First Name
*
Last Name
*
Sex
*
M
F
Birth Date (mm/dd/yyyy)
*
Age (as of 6/26/17)
*
All Known Allergies (if applicable)
Parent/Guardian's Primary Contact
First Name
*
Last Name
*
Relationship to Participant:
*
Mother
Father
Grandparent
Guardian
Other
Other
Address 1
*
City
*
State
*
Zip
*
Email Address
*
Home Phone
*
Mobile/Alternate Phone
SCYC Member Information
*
SCYC Member Information
Member Name
SCYC Member Information
Member #
SCYC Member Information
Emergency Contact
Emergency Contact
Check box if Emergency Contact information is same as above
First Name
Last Name
Relationship to Participant:
Mother
Father
Grandparent
Guardian
Other
Other
Home Phone
Mobile/Alternate Phone
Email Address
Medical Waiver
Click here for Junior Medical Waiver
Medical Waiver Acknowledgement
*
I have read & acknowledged the agreement, waiver and release of the above mentioned junior medical waiver.
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Seawanhaka Corinthian Junior Yacht Club
314 Yacht Club Road
Oyster Bay, NY 11771
Phone: (516) 922-6200 ext.117
Fax: (516) 922-6203
Email: JuniorClub@seawanhaka.org
www.seawanhaka.org