Whitewater Information and Payment

Please read carefully and complete the following form…

Please complete and submit this form with your payment by April 1. If for some reason, you are unable to make the whitewater rafting trip on May 21, please notify Mark Bradford asap at mbradford@ReginaAcademies.org. We do have a few people on a waiting list who will be happy to take your place.

IMPORTANT: Pocono Whitewater requires that each rafter present a liability waiver when they arrive. You can download and print the waiver form here. Again, one form for each rafter. Parents will sign the waiver for children under 18. BRING THESE FORMS WITH YOU ON MAY 21.

Please make your payment by April 1 in one of two ways:

• Venmo the total due to Mark Bradford @Mark-Bradford-14. Make sure you include your name when you submit your payment.
• A check made payable to “Mark Bradford” and sent to: Regina Academies PO Box 465 Wynnewood, PA 19096

Please complete the following form.

Total number of rafters *

• 2 (dad and 1 son) - $ 86.00
• 3 (dad and 2 sons) - $ 129.00
• 4 (dad and 3 sons) - $ 172.00

Dad's Name *

First

Last

Son's Name *

First

Last

Son #2 Name

First

Last

Son #3 Name

First

Last

Please confirm that everyone in this group is at least 8 years old *

• Yes
• No

Ordering Lunch?

Lunch is available for purchase at $10 each and includes a 6" sandwich, chips, water, and a cookie. If you would like to purchase, please indicate how many lunches you would like to order and make your selections below. They will be ready for you when you arrive.

Number of sandwiches: 0

TurkeyQuantity1234

Ham & CheeseQuantity1234

VeggieQuantity1234

PB&JQuantity1234

Total payment due (rafting and lunch):

$ 0.00

In Case of an Emergency:

Emergency Contact Information

Please enter the name of someone we should contact in case of an emergency.

Relationship *

• Parent
• Relative
• Friend

Name of emergency contact: *

First

Last

Phone of emergency contact: *

Check List: *

• This form filled out and to be submitted by April 1.
• Payment made by check or Venmo to Mark Bradford by April 1.
• Liability waiver printed out and competed. You will bring this with you on the day of the trip.

Submit