AQUA 101 Summer Program Online Registration Form

Participants must be age 9-13.

Form fields with * are required to register.
Please contact us if you have any questions.

Program Information

Mondays-Fridays 10AM - 4PM

Student Information

Month / Day / Year

Example: 718-555-1212

Email is the primary means of communication throughout the program. Be sure you check the email address you provide to us frequently. If you do not have regular internet access, please let us know and we will work to accommodate you.

Emergency Contact 1

Emergency Contact 2

About You

Please select all that apply...

 Community Service Projects
 Field Trips
 Biking
 Kayaking
 Surfing
 Summer Camp
 Urban Planning
 Gardening
 STEM
 Other 
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