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Cygnus Diving
Welcome
Pre-Registration Form

Please fill out the form below to reserve your place with the Cygnus Diving Club. If you have any other questions, please use our comment box below. Welcome to our club!

First Name:   Last Name:

Gender: Male Female   Birthdate:

Mailing Address:   Telephone:

Diver's Email Address:   Health Card #:

Allergies / Conditions:   Medications:

Parent's Names:   Parent's Email Address:

Program:

Days You Wish To Dive? Monday  Tuesday  Thursday  Saturday

How Did You Hear About Us? Friend  Advertisement  Pamphlet  Other

Questions or Comments:

All payments for registration must be done at the pool. Please do not submit credit card numbers using this form. The Cygnus Diving Club only accepts cash or cheques as forms of payment.

This form is used for reservation purposes. Please ensure that all information is correct to the best of your knowledge. Please click the submit button below to reserve your place. Thank you.




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