Portage Quarry Dive Instructors, Assistant Instructors
and Dive Masters Application and Insurance Information

Instructor Insurance Verification

Please ensure we have this information updated for 2012 before training begins. Also see insurance notice below.

Portage Quarry Recreation Center, Inc.

Apply below or click here to download a PDF application.

First Name:
Last Name:
Street Address:
City:
State/Province:     Zip:
Phone:
Birth Date: Instructor No:
Which Agency: Other:
eMail:
Your Dive Center/
Store Affiliation:
Insurance Policy Name:
Policy Number:

Important Notice: Portage Quarry is also requiring a 2012 current copy of your insurance policy to have on file with the following entity named as an additional insured on the individual’s instructor liability insurance policy.

Portage Quarry Recreation Center Inc.
12701 South Dixie Highway
Bowling Green Ohio, 43402
419-352-9203

 

 

Instructors dive for free when they are with students and teaching a class.


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E-MAIL JEFF AT THE QUARRY", CLICK ON IMAGE
AT LEFT FOR A PICTURE OF QUARRYMAN

12701 South Dixie
Bowling Green OH, 43402
(419) 352-9203

© 1999 - 2012 Portage Quarry Recreation Facility
All Rights Reserved