PARTNERS IN THE PARKS
EVERGLADES
REGISTRATION FORM

Year Project

First Name
Last Name

Address
City
State/Province
Postal Code
Country

Phone
University/college
Email

SKILL LEVEL - SWIMMING, CANOING/KAYAKING
SWIMMING Strong
Average
Weak
Non-swimmer 		CANOEING
KAYAKING 		Expert
Novice
Beginner
No experience
PHYSICAL CONDITION  
Please indicate any physical conditions or restrictions you have:
 

Respiratory
Joint problems
Back problems
High blood sugar
Low blood sugar
Seizures

 
Please indicate if you have allergies or other diet restrictions.
  Lactose intolerant
Sugar restricted
Vegetarian
Vegan
Food Allergy

Describe food allergy if checked:
SAFETY TRAINING
Please indicate if you are currently certified in any of the following:
  Red Cross First Aid (or equivalent)
Red Cross Life Guard (or equivalent)
Wilderness First Responder
REGISTRATION FEE
How would you like to pay your registration fee?


Credit Card
Check