Kelowna Springboard Diving Club Online Registration

Welcome! Once your have registered, please head to the parent portal to select your class.

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Referral Information

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Referral Name

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

Province*

Postal Code*

Primary Phone*

Contact #1

Contact #1 First Name*

Last Name *

Type

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Work #

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Confirm Email*

Portal Account Password

Confirm Portal Account Password

Contact #2

Contact #2 First Name

Last Name

Type

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Home Phone

Work #

Cell #

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

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Student Gender*

Birth Date*

Additional Info

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Special Needs (Leave blank if NONE)

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Primary Doctor

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Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size*

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Grade Level

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Student #3 (Show-Hide Details)

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Birth Date*

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School

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Medications (Leave blank if NONE)

Primary Doctor

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Primary Doctor

Student #5 (Show-Hide Details)

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Student Gender*

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Additional Info

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School

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Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

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Primary Doctor

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Payment Information

Credit Card

Card Number *

Exp Month *

Exp Year *

Card Nickname

Name as it appears on card *

Address Line 1

Address Line 2

Country *

City

Province*

Postal Code*

Registration

Referral Information

Family Information

Where do you live?

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

Contact #2

How can we contact you?

Student #1

Additional Info

Student #2 (Show-Hide Details)

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Student #3 (Show-Hide Details)

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Student #4 (Show-Hide Details)

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