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This Summer

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Information for Registrants and Parents

Thank you for registering for LYS online! By filling out this simple form we will have the information we need for you or your child to attend LYS this summer. Please note that information about tuition, what to pack, etc. can be found in a password protected place on our web site after you fill out this form. The username and password will be emailed to you after registration- there you can download the correct medical and media release form that your child will need to bring to LYS this summer.

* denotes a required field

Student Information
	First	Last
Name	*	*
	Male Female *
Race
Address	*
City	*
Zip	*
Phone	( ) - *
Alternate Phone	( ) -
Email
Confirm Email
School	* Limit 20 students per school
Grade you will be in *
Have you previously attended LYS? Yes No
Delegate's Personal Phone #
Delegate's Email
Indicate below the name, phone number and email of the person who recruited you.
Name
Phone	( ) -
Email
Indicate below the name of the person who should be contacted in the event of an emergency.
Name	*
Relationship	*
Phone	( ) - *
Alternate Phone	( ) -
Billing Information
Amount of Payment		Payment Type *
Billing Information - Click here if it is the same address as above
Name	*	*
Address	*
City	*
State	*
Zip	*
Email	*
Phone	( ) - *
Credit Card Number
	Exp Mo:	Exp yr: