Paddle Program-Participant Registration
Paddleboards, Kayaks and Life Vests provided, along with trained instructors.
Participants under 18 and those needing personal care assistance must have a parent or guardian present at all times.

We look forward to paddling with you this summer!

Participant First Name *
Your answer
Last Name *
Your answer
How did you first hear about DREAM? *
Required
Street Address *
Your answer
City *
Your answer
State (Two letter abbreviation) *
Your answer
Zip *
Your answer
Cell Phone Number *
Your answer
Email Address - we will share important program information via email. *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Emergency Contact Name *
Your answer
Emergency Contact Phone Number *
Your answer
Next
Never submit passwords through Google Forms.
This form was created inside of DREAM Adaptive Recreation. Report Abuse - Terms of Service