Yardie Divers Marine Summer Camp Registration Form

Yardie Divers Marine Summer Camp Registration Form

To register for a place in the the camp, you must complete the form below accurately.
Campers Name:*

First NameLast Name
Birth Date:*

MonthDayYear
Phone Number:*

Area CodePhone Number
Email Address:
Primary Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Select shirt size:

SmallMediumLargeExtra-large
How did you hear about our Marine Summer Camp?:

School Information
School Name*
School Address

Street Address

Street Address Line 2

CityParish

Country
High School Phone Number*

Area CodePhone Number
Year in School:*

Family Information
Parent/Guardian's Name:*

First NameLast Name
Contact Phone Number:*

Area CodePhone Number
E-mail Address:*

Emergency Contact Information
Emergency Contact1 Name:*

First NameLast Name
Emergency Contact1 Phone Number:*

Area CodePhone Number
Relationship to Student:*
Emergency Contact2 Name:*

First NameLast Name
Emergency Contact 2 Phone Number:*

Area CodePhone Number
Relationship to Student:*

Your Reason For Attending This Camp
In 300 words or less, please describe your reasons for wishing to attend this camp.

0/300
Should be Empty: