Name: WHALE Tales Water Safety Program
Start: 2025-06-23T10:00:00-04:00
End: 2025-06-26T11:30:00-04:00
Location: Tri-Town Youth Services

Participant First Name*

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Participant DOB

Please list any allergies participant has*

Which School does Participant attend?

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Parent/Guardian Last Name*

Parent/Guardian Email*

Phone

Name of individual picking up participant*

Emergency Contact Phone Number*

Emergency Contact Name*

I grant Tri-Town Youth Services permission to use my/my child’s image in photos or videos for promotional, educational, and outreach purposes, including print, digital, and social media. I understand no compensation will be provided, and I release Tri-Town Youth Services from any liability related to image use.*

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WHALE Tales Water Safety Program

June 23 @ 10:00 AM - June 26 @ 11:30 AM

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