Print out this application (click File...Print on the browser menu), fill it out and Mail application and fee to:

Durland Scout Center
310 Stuyvesant Avenue
Rye, NY 10580
______________________________________________________

SCUBA COURSE REGISTRATION
(please print)

NAME_____________________________AGE_______DATE OR BIRTH___________

ADDRESS______________________________________________________________

CITY______________________________STATE____________ZIP_______________

EMAIL______________________________

FEE ENCLOSED $___________
(make check payable to Durland Scout Center BSA)


__________________________________ __________________
(Signature Of Student) (Date)

Permission is hereby granted for my son/daughter (age 15 to 18) to participate in this SCUBA diving course:


__________________________________ __________________
(Signature Of Parent / Guardian) (Date)

IF APPLICABLE
BSA UNIT#________LOCATION___________________________