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 LEADER REGISTRATION FORM

Name *
Name
Gender *
Date of Birth *
Date of Birth
Address *
Address
Phone Number *
Phone Number
Phone 1 *
Phone 1
Phone 2
Phone 2
Allergic to Bee Stings? *
Are you covered by family medical/hospital insurance? *
Photo & Video Permission *
My permission is granted for SBYC to photograph or videotape the individual of this form, whether minor or adult, during camp events that may be used as camp promotional materials.
By typing your name, you are signing the agreement which will be regarded as your handwritten signature.