Contact Information

Full Name
Address
City State      ZIP

Phone Home Work  Cell
Alt. Phone
Email Address

Volunteering Information

Captain    Volunteer Escort    Maintenance   
Shows    Office    Fundraising

Captain's License Type

The following information is personal and not required:

Age     Gender Unanswered Male Female
Notable Health Problems / Impairments

Do You Own a Boat? No Yes     Boat Type

Do You Drive a Vehicle? No Yes
Would You Need Gas Money? No Yes

Do You Know A Handicapped Person? No Yes

Have You Ever Been Convicted of a Crime? No Yes

Fishing & Boating Experience

How did you hear about Excalibur Leisure Skills?
Friend / Realtive Brochure Display (Erie County Fair, etc.) Saw Boat at Marina or on Lake Search Engine Link From Another Site Other / Don't Remember