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2. Boater Safety Class Registration

   You will be notified by telephone to confirm your registration the week of the class.

4. Date
   -- Select One --Saturday, April 21, 2018Saturday, May 12, 2018Saturday, May 26, 2018Saturday, June 9, 2018Saturday, July 21, 2018

   Please select the date of the Boater Safety Class you would like to attend.

6. Participant's Name
7. Date of Birth
9. Address
11. City
12. State
13. Zip Code
15. Phone Number
17. Parent/Guardian Name
18. Parent/Guardian Telephone Number
    If different from participant's
20. Emergency Contact
    For day of class
21. Emergency Contact Telephone Number
Leave This Blank:


23. 1. Receive an email copy of this form.
24. Email address

    This field is not part of the form submission.

25. Submit Submit and Print

* indicates a required field