Catholic Youth Camp
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= Required Fields

Account Type

Select Account Type:

Primary Contact for account

Enter the information for the primary contact for this account. This person must be an adult.
First Name:

Last Name:

Middle Initial:
Nickname:
Gender:
Birth Date:

mm / dd / yyyy
Address:

City:

State / Province:
*
Zip / Postal Code:

Primary Phone
*



Alternate Phone:
*
Ext.



Alternate Phone 2:
*



E-mail Address:
*
Confirm E-mail Address:
*

Additional Contact for account

Add an additional contact for this account by completing the information below.
This person is:
First Name:
Last Name:
Middle Initial:
Nickname:
Gender:
Birth Date:

mm / dd / yyyy
Address:
 
City:
State / Province:
Zip / Postal Code:
Primary Phone:


Alternate Phone:
Alternate Phone Ext:

Alternate Phone 2:

E-mail Address:
Confirm E-mail Address:


Additional Information

Please provide the following information
Someone who refers you receives special awards. If you are new to CYC, please indicate who referred you to us.
Please detail special circumstances which may not be reflected in your financial statements

Login Information

The username and password must consist only of letters and/or numbers.  No special characters or spaces are allowed.
Username:
Password:
*
Confirm Password:
*
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2233 Hamline Ave. Suite B1 • Roseville • MN • 55113 • 651-636-1645
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