Name
*
Home Phone
Home Address
City, State, Zip
Email
*
County/City of Residence
School
Grade
Sex
Male
Female
Preferred Roommates
We have read, understand, and agree to comply with the conference guidelines found below this form.Furthermore, in the event that medical services are required , we authorize the Virginia YMCA to arrange for such service in a manner that it deems appropriate.
Program Guidelines:
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