* = Required Information

First Name: *   Last Name: *

Address1: *

Address2:

City: *    State/Province: * 

Zip/Postal Code: *    Country: *

Home Phone: *   Parent/Guardian Phone:

Email: *

Gender: Male    Female    

Age:     Birthdate:

  Primary Language:     School Complete:

T-Shirt Size (ex. S, M, L, XL):     

Emergency Contact:

Full Name: * Relationship: *

Home Phone: *   Work Phone:

Cell Phone:

Additional Infomation:

Do you have any special needs or consideration? (e.g allergies, medications, special needs):

Please rate your swimming ability: Fair   Good   Excellent   
Comments:

Please rate your snorkeling experience: Fair   Good   Excellent   
Comments:

Please rate your marine mammal knowledge: Fair   Good   Excellent   
Comments:

How much experience do you have with Marine Mammals:
None    Some    A Lot    
Comments:

What interests you most about marine mammals?
What do you hope to learn during the program?

Describe your participation in any environment groups or organizations:

Please share additional comments:

Would you like us to pass your information on to other participants prior to arrival:
Yes, pass on my info   No, thank you  

 Class Cancellation Policy:

Upon acceptance to one of our classes, you are required to submit a 50% deposit to confirm your spot in the requested class. The remaining balance for the class is due 30 days prior to the class start date. If payments are not made in full at this time, your deposit will NOT be refunded and your application will be terminated. All cancellations must be made in writing (e-mail is acceptable, upon confirmed receipt of message). If a confirmed reservation is canceled no less than 60 days prior to the class starting date, a full refund will be given (deposit and tuition, where applicable). If a reservation is canceled less than 60 days, but more than 30 days prior to the class starting date, tuition (if applicable) and50% of the deposit will be refunded. No refunds will be given for cancellations made less than 30 days prior to the class start date. If a student must cancel during this time, all deposit and tuition fees will be withheld. No exceptions!

In the event that the class minimum requirement of 4 students is not met by 30 days prior to the program start date, the class will be canceled. All students/parents will be contacted immediately, and a full refund will be issued.

I have read and agree to all terms outlined above regarding the Dolphins Plus class cancellation policy. I understand that I will NOT be refunded for a cancellation made less than 30 days prior to the class start date. I also understand that if I am not able to complete payment of tuition in FULL by 30 days prior to class start date, Dolphins Plus will not refund my 50% deposit, and my application will be terminated.

By submitting this application, I hereby certify that I have read all of the information above and that all personal information is correct and up to date.