Participant Information and Questionnaire
Date of Birth
Emergency Contact (someone not participating in the class with you)
Emergency Contact Number
Please upload a copy of your DD214 or VA Card
VA Disability Rating
Would you like assistance in establishing VA benefits?
Who would you like to learn how to dive with? (Check all that apply)
Above Persons Name(s) and Date of Birth
What is your availability for training?
If availability above is other, what is your availability?
Would you like child care? (Ages 10 and up are welcome to participate)
Do you have any specific concerns or medical issues that you feel might be a barrier to learning how to scuba dive?
Our goal is to assist our fellow veterans in learning new skills that reinforce medical and mental health treatments, develop and foster existing family relations and create a life-long hobby. This is a get-give program. Our hope is that once you learn (get) a new skill, you will be inspired to help (give) other veterans and the local community, and have fun along the way!
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