Patriot Dive Club - New Diver Application

Copy and paste all of this information in the body of an email (highlight this entire application…right click and select copy…go to the body of an email and left click, select paste), provide the information and send to:  Patriotdive@aol.com

Divers Name: 

Date of Birth: 

Current Age: 

Mom’s Name: 

Dad’s Name: 

Best Phone Number: 

2nd Phone Number: 

Email Address: 

Street Address: 

City: 

Zip: 

Have you dived with another club in the past 12 months? 

What club and who was the coach? 

Tell us all about your diving background…summer, winter, HS, types of dives, one meter, three meter, platform, awards, accomplishments…everything!

Tell us about other sports that might be of interest to diving…gymnastics, trampoline, tumbling, dance, martial arts, etc.

What type of diving program are you looking for?

Full-time, year round training

Seasonal diving (High School, PreSummer)

Lessons (one or two days/week)

Not really sure

Any medical conditions that the coaching staff should know about?