Boater Education & Pump Out Request Form
ATTENTION STATEMENT: MUST READ

**Due to unsafe working conditions the program will be closed SUN 1/13. We apologize for any inconvenience.

We are in the Off Season, and available to provide pump outs for Boaters in Hampton Roads on Saturdays and Sundays.

*The program is limited to offering pump outs in Williamsburg, Gloucester (Hayes), York, Suffolk and Smithfield only on the 2nd weekend of each month until further notice. All other Cities have no restrictions.

*The maximum gallons per appointment is 25.

The Program is operating with a smaller, student intern staff. We do our best to accommodate your requested day, but this is not a guarantee. We appreciate your flexibility, and want to thank everyone for protecting our environment and the public by using pump outs.

You must request a pump out by NOON on FRIDAY

*Late requests are not guaranteed and may be moved to the following weekend.
*Confirmation calls/texts are done on Friday between 12-3 for the current weekend.
*All appointments are weather and crew safety dependent.

*The interns thank you kindly, but cannot accept tips.

*The phone line and online platform is checked on Fridays and Saturday mornings.

I have read the Attention Statement above *
Required
Marina Name or Residential Address *
Your answer
Name *
Your answer
Boat Name *
Your answer
Dock / Slip *
ie D12
Your answer
Phone Number (Required) *
ie 757-123-4567
Your answer
Request Weekend - Saturday or Sunday - ONLY *
*Please see attention statement above for request deadline and program closures.
MM
/
DD
/
YYYY
Requested Day Preference *
Check all that apply. Preference is not always guaranteed.
Required
How would you like to receive your pump out confirmation? *
appointments are confirmed Thursday / Friday between 12-3pm. Check all that apply
Required
Cell Carrier* If requesting text confiramtion
*ie Verizon, Tmobile, ATT etc.
Your answer
How many waste tanks do you have? *
Estimated gallons to be pumped out?
The max amount per appointment is 50 gallons.
Your answer
The crew cannot board your boat without you or other persons responsible for your boat is present. *
The crew may only pump out without the owner present if they can reach the waste tank from the dock and the owner gives permission.
Optional: additional comments
Your answer
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