Scuba
Parent Name
*
First Name
Last Name
Camper Name
*
First Name
Last Name
Parent Email
example@example.com
Camper Age
*
Which program are you interested in for your camper?
Intro program (July 12 to July 25)
Intro program (July 26 to August 8)
Intro program (August 9 - August 22)
Certificate Program - Session 1 ($200 fee payable at program completion)
Certificate Program - Session 3 ($200 fee payable at program completion)
I understand that the Certificate Program includes several hours of book work, and a $200 fee. It is also not on a first come basis and preference is given to experience.
*
Date
*
-
Month
-
Day
Year
Date
Submit
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