Summer Clinic Online Registration (Submit by May 30th, 2024)

First Name

Last Name

Address

City, State

Zip

Home Phone (XXXXXXXXXX) (If No Home Number Enter Cell Number)

Cell Phone (XXXXXXXXXX) (If No Cell Number Re-Enter Home Number)

Email

Age

Height

Weight

Gender
MaleFemale

List any boating or whitewater experience you have:

List any other information you'd like us to know (e.g. please put me in the same (or different) team as my daughter):