Open Water

GSTA Open Water Scuba July 14th - 20th
Teens can only participate in one dive adventure per year as their skills progress. The order of progression for dive adventures is Year 1 - Open Water, Year 2 - Advanced, Year 3 - Wreck Trek and Year 4 - Rescue Diver.
To secure your application the GSTA waiver must be submitted along with a $200 deposit. The link for the waiver is at the end of this application. The deposit will be returned to you after your teen has attended the adventure, however if your teen does not attend the deposit will help GSTA cover the expenses incurred. Deposits can be mailed to Gold Star Teen Adventures, 2504 Raeford Road Suite 200, Fayetteville, NC 28305 or submitted via PayPal

It is the foundation’s policy that when a teen withdraws from an adventure, after the deposit has been paid, the teen will not be able to participate in future GSTA events. Along with taking a slot from another teen, many expenses are paid in advance and those expenses are not able to be recouped.
Teen's Name *

First Name Last Name
Date of Birth *

Month Day Year
Date Date Picker Icon
Gender

Male Female
Age *
Grade *
Teen's Phone Number *

Area Code Phone Number
Teen's Email *
example@example.com

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

How did you hear about GSTA? *
Shirt Size? *
Shoe Size? *
Parent's Name *

First Name Last Name
Parent's Email *
example@example.com
Parent's Phone Number *

Area Code Phone Number
What activities does your teen participate in throughout the year? *
Closest INTERNATIONAL Airport *
Has your teen ever flown alone? *

Yes No
Does your teen have scuba diving experience? *

Yes No
Is your teen comfortable talking about their loss? *

Yes No
Spouse's Name *
Spouse's Date of Death *

Month Day Year
Date Date Picker Icon
Spouse's Occupation *
Relationship of Fallen Hero to teen *
Does your teen have any allergies or medical diagnosis (if yes, please explain) *
Does your teen have emotional, physical or medical needs our staff should be aware of? *
Can we honor your Fallen Hero on our website's Tribute page? *

Yes No
I grant permission to Gold Star Teen Adventures INC., its representatives, partnering foundations, vendors and staff/mentors to use any photographs of myself or of my property. I authorize Gold Star Teen Adventures INC., its assigness and transferees permission to use and publish the same in print and /or electronically. *

Yes No
My teen has permission to be administered topical ointment for cuts and for minor injuries by GSTA staff, if necessary. *

Yes No
My teen has permission to be administered over the counter medication (i.e. but not limited to Tylenol, Motrin) for headaches, nausea, and minor injuries by the GSTA staff, if necessary. *

Yes No
The two forms below must be printed, signed, and returned along with the $200 deposit for your teen to be put on the roster for the adventure.

Participant Waiver

Participant Code of Conduct
Enter the message as it's shown *
Should be Empty:

GSTA Open Water Scuba July 14th - 20th