Telephone: (410) 761-4520
City :_____________________ State: _____ Zip Code:________ Phone(W):(___)___________
Driver's License ________________________________________Email________________________
Education: Graduated Current Year Major
High School __________ ___________ _______
College ___________ ___________ _______
Graduate/Vocational Work __________ ___________ ________
Swimming Ability: Poor ______Fair _____Average _____ Good_____ Excellent _____ American Red Cross Swimming ______Life Saving ______ WSI ________ Other__________
Special Interest _________________________________________________________________
Reason for wanting to take SCUBA: _______________________________________________________________________________
How did you hear about our program (i.e. radio, TV, newspaper, friend, One Book, Yellow pages)?
The cost of the class room and pool sessions is $245.00 I have included a deposit of $125.00 with this application.
The course fee includes a $25.00 non-refundable registration fee.
A $15.00 a day certification fee is required when certification is done locally.
AFTER THE SECOND CLASS, ALL FEES ARE FULLY EARNED
Note: Students under 18 - we welcome your enrollment, however, it is necessary that your parent, or guardian’s sign below.