Sign-up Form

Please complete this form and submit it before the 26th of this month to reserve your a spot for Underwater Hockey lessons offered on the 28th of this month.

Fields in red are required.

Name (first, last):

City:

State:


Zip:

Phone number:

E-mail:

Student status:	Junior Sophomore Senior Graduate

Do you have prior experience practicing Underwater Hockey?	Yes No

Please review your information, and click on the Submit button.