Guest or Special Event Sign UpRequired items indicated by * Applicant Type * Please select one. Guest Special Event If "Special Event," please provide name of event. First Name of applicant * Preferred Name (if different) Last Name of applicant * Date of Birth * MM DD YYYY Gender * Male Female Phone * Parent/Guardian if applicant is a minor. (###) ### #### Address * City * State * CA AL AK AS AZ AR CO CT DE DC FL GA GU HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND MP OH OK OR PA PR RI SC SD TN TX UT VT VA VI WA WV WI WY OTHER Zip code * Parent/Guardian 1 First Name (if applicant is a minor) Parent/Guardian 1 Last Name (if applicant is a minor) Parent/Guardian 1 Phone (if applicant is a minor) (###) ### #### Parent/Guardian 2 First Name (if applicant is a minor) Parent/Guardian 2 Last Name (if applicant is a minor) Parent/Guardian 2 Phone (if applicant is a minor) (###) ### #### ACCOUNT First Name of account holder * Name of the person financially responsible for the applicant. Name may be same as applicant. Often parent/guardian for minor. Last Name of account holder * Email of Account Holder * This is where invoices will be sent (if an invoice is required). EMERGENCY INFORMATION Emergency Contact * Emergency Contact Phone * (###) ### #### 2nd Emergency Contact 2nd Emergency Contact Phone (###) ### #### Medical Doctor's Name Not required but strongly encouraged, especially for minors. Medical Doctor's Phone (###) ### #### Medical Carrier United Healthcare, Kaiser, etc. Medical Carrier Phone (###) ### #### Medical Notes Please let us know of any medications or conditions we should be aware of for the applicant. OTHER Ethnicity * We use this information when applying for grants only. American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander Hispanic, Latino, or Spanish Origin White Mixed Heritage Decline to State Referral source * How did you hear about us? SDCKT member Facebook Instagram Internet search - Google, Yahoo, etc. Saw people paddling Other
