Pleasant Bay Community Boating Online Registration

Registration

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If cost is a barrier, please contact info@pbcb.cc and we can discuss financial assistance/payment plans. Programs and prices are subject to change. We will charge a $100 non-refundable deposit per class at the end of the registration period, which will be credited towards your course fees when your full balance is charged on April 1st. No refunds will be given for any changes or cancellations made May 1st or beyond.

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Contact #2 First Name*

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Student #1

Student's First Name*

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Additional Info

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Grade Level*

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Student's First Name*

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Student Gender*

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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*

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Student's First Name*

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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*

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Disabilities (Leave blank if NONE)*

Special Needs (Leave blank if NONE)*

Allergies (Leave blank if NONE)*

Medications (Leave blank if NONE)

Primary Doctor*

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Student's First Name*

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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*

Immunization Notes*

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Zip*

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Where do you live?

Additional Info

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Student #1

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