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IMPORTANT INFORMATION
 
Register

* indicates a required field.

User Account Information
User Name:
*
Password:
*
Contact Information
Diver's First Name:
*
Diver's Last Name:
*
Home Phone:
Work Phone:
*
Cell Phone:
*
Parent 1 Name:
*
Parent 1 Email:
*
Parent 2 Name:
Parent 2 Email:
Street Address:
*
Apt #:
City:
*
ZIP Code (5 digit):
* 
Emergency Contact Name:
*
Emergency Contact Phone:
*
Membership Information
Age:
*
Date of Birth:
*
AAU Diving Number:
*
USA Diving Number:
Insurance Carrier:
*
Policy No.:
*
Lesson Information
Start Date: *
Please select the group the diver is signing up for
Diving Group:
For Lessons and Intermediate Groups, Select Days:
Monday Tuesday Wednesday Thursday Saturday
*
I understand that there are inherent dangers involved in the sport of diving, as well as in the use of related training devices such as the trampoline and dry land equipment, both of which are optional. I further understand that participation in this program may expose oneself to certain risks of injury. I freely and voluntarily assume any and all risks of injury, and hereby release the Cougar Diving Club and the University of Houston, the diving coaches, its regents, officers and employees from any and all claims or liabilities for injuries in any way arising from participation in the Cougar Diving Club’s program.
*
I have printed and filled out the (Please bring filled out form to the first lesson).
Submit
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