NEIGHBORHOOD CAPTAIN REGISTRATION

Please fill out the information below to sign up!

If you are a member of a team, please indicate your team name in the field below.

You will receive confirmation via email along with your Go to Guide answering your questions.

Before registering, please review the Dermer Dream's Release & Waiver.

Student First Name

Student Last Name

Cell Phone

Address

City

State

Zip Code

Parent or guardian name (18 years or older)

Were you referred by someone? Enter their name here!

Are you a part of a team? Please enter your Team's name below

By clicking here, my Parent or Guardian and I, agree that we have read the Rules & Regulations noted in the Neighborhood Captain section of this website and in the Release and Waiver.Click here to view the Dermer Dreams Release & Waiver.

NEIGHBORHOOD CAPTAIN REGISTRATION

Thank you for signing up to be a Neighborhood Captain! Please check your inbox.