NOTE: Aquatic Center Inc. does not accept paper waivers, please submit electronically.

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Read the document

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Fill in Full Name

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Fill in Email Address

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Fill in Cell Phone Number

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Fill in High School

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Fill in Grade Point Average

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Select Did you graduate

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Fill in College or Technical School

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Fill in College Grade Point Average

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Select College Graduate

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Fill in First Job Title

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Fill in First Employer Name

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Fill in First Employer Email

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Fill in First Employer Phone

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Fill in First Start Date

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Fill in First End Date

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Fill in First End Wage

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Fill in Second Job Title

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Fill in Second Employer Name

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Fill in Second Employer Email

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Fill in Second Employer Phone

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Fill in Second Start Date

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Fill in Second End Date

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Fill in Second End Wage

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Fill in Third Job Title

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Fill in Third Employer Name

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Fill in Third Employer Email

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Fill in Third Employer Phone

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Fill in Third Start Date

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Fill in Third End Date

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Fill in Third End Wage

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Fill in Fourth Job Title

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Fill in Fourth Employer Name

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Fill in Fourth Employer Email

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Fill in Fourth Employer Phone

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Fill in Fourth Start Date

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Fill in Fourth End Date

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Fill in Fourth End Wage

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Fill in Fifth Job Title

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Fill in Fifth Employer Name

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Fill in Fifth Employer Email

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Fill in Fifth Employer Phone

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Fill in Fifth Start Date

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Fill in Fifth End Date

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Fill in Fifth End Wage

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Fill in Sixth Job Title

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Fill in Sixth Employer Name

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Fill in Sixth Employer Email

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Fill in Sixth Employer Phone

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Fill in Sixth Start Date

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Fill in Sixth End Date

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Fill in Sixth End Wage

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Fill in First Reference Name

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Fill in First Reference Email

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Fill in First Reference Phone

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Fill in Second Reference Name

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Fill in Second Reference Email

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Fill in Second Reference Phone

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Fill in Third Reference Name

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Fill in Third Reference Email

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Fill in Third Reference Phone

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Fill in Fourth Reference Name

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Fill in Fourth Reference Email

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Fill in Fourth Reference Phone

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Fill in Fifth Reference Name

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Fill in Fifth Reference Email

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Fill in Fifth Reference Phone

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Fill in Sixth Reference Name

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Fill in Sixth Reference Email

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Fill in Sixth Reference Phone

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Select Driver's License

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Select Boating License

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Select Boating Experience

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Select Swim

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Select Smoke or Vape

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Select CPR Training

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Select First Aid Training

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Select Mechanical Experience

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Select Computer Skills

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Select Athletic

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Select Back or Knee or Other Injuries

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Select Take Medications

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Fill in Helpful Qualities

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Add your signature

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Select Electronic Signature Consent