Student Registration 1

UTD Student Registration Form

If you are taking a sanctioned UTD Class from a UTD Instructor then:

- Fill this Form Out
- Print Before Send
- Bring to first day of class to sign in front of your instructor

STOP!!! Print before submitting

By electronically submitting this form I agree to be bound by it contents as if I had signed it in person.

PLEASE SIGN IN FRONT OF YOUR UTD INSTRUCTOR

Signature: _________________________________________________________

Printed Name: ______________________________________________________

Date: ___________________

I am a minor and my parent or guardian has signed below.

Signature of parent or guardian if Participant is a Minor, and by their signature they, on my behalf release all claims that they and i have.: _________________________________________________________

Printed Name: ______________________________________________________

Date: ___________________

For General Information please contact: info@unifiedteamdiving.com