Your First Name (required)
Your Last Name (required)
Your Date of Birth (required)
Your Street Address (required)
Your City (required)
Your State (required)
Your Zip Code (required)
Your Email (required)
Your Phone Number (required)
If under 18, Guardian's Name
Select your Shirt Size ---SmallMediumLargeX-Large
Select your Role ---ParticipantVolunteer
Your Agency ---Camp ImuaSpecial OlympicsMDAAutism SpeaksLa'akeaOther
Notes or Questions?
Date: Saturday, May 18, 2019
Time: 8:00am – 12:00pm
Place: Kanaha Beach Park 1st Parking Lot
Bring: Water, Sunscreen/Hat, swimwear
Please Register by May 14th