First Name*Last Name*Date of Arrival*May 3rd, 2018May 4rd, 2018Time of Arrival*Between 2 and 4After 4Explanation*Has your contact information changed since the last program?*Special Dietary Needs / Preferences*Do you plan to Linger Longer on May 5, 2018?*(If yes, please call Jekyll Island Club Hotel (912) 635-2600 or 1-(800) 535-9547)YesNoRegister for “Derby de Mayo” $50.00 per person* Price: $50.00 Quantity: Number of children to register for LGA Play ($50 per child)*NoneOneTwoThreeFourLGA Play RegistrationLead, Give, Play Ages 4+ Cost: $50 per person Includes: Care, Dinner and Fun from 6-10:30pm May 4th Care, Leadership Activities and Fun from 9-12pm on SaturdayMother's Name* First Last Mother's Cell Phone*Father's Name* First Last Father's Cell Phone*Emergency Contact Name* First Last Emergency Contact Number*Best Contact Email* Enter Email Confirm Email Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Child #1 QuestionsChild's Name* First Last Child's Gender*MaleFemaleAge as of May 4th*Please enter a number from 4 to 18.T-shirt Size*Youth SmallYouth MediumYouth LargeYouth XLYouth XXLAdult SmallAdult MediumAdult LargeAdult XLAdult XXLAny special needs or challenges?Any dietary restrictions?If over the age of 13, would they like to be a junior counselor and help lead activities instead of participate?*YesNoChild #2 QuestionsChild's Name* First Last Child's Gender*MaleFemaleAge as of May 4th*Please enter a number from 4 to 18.T-shirt Size*Youth SmallYouth MediumYouth LargeYouth XLYouth XXLAdult SmallAdult MediumAdult LargeAdult XLAdult XXLAny special needs or challenges?Any dietary restrictions?If over the age of 13, would they like to be a junior counselor and help lead activities instead of participate?*YesNoChild #3 QuestionsChild's Name* First Last Child's Gender*MaleFemaleAge as of May 4th*Please enter a number from 4 to 18.T-shirt Size*Youth SmallYouth MediumYouth LargeYouth XLYouth XXLAdult SmallAdult MediumAdult LargeAdult XLAdult XXLAny special needs or challenges?Any dietary restrictions?If over the age of 13, would they like to be a junior counselor and help lead activities instead of participate?*YesNoChild #4 QuestionsChild's Name* First Last Child's Gender*MaleFemaleAge as of May 4th*Please enter a number from 4 to 18.T-shirt Size*Youth SmallYouth MediumYouth LargeYouth XLYouth XXLAdult SmallAdult MediumAdult LargeAdult XLAdult XXLAny special needs or challenges?Any dietary restrictions?If over the age of 13, 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