REGISTRATION
Child’s
Name________________________________________________________________
Current
Age_____________________________
Male ______ Female
______
Height _____________________ Weight ____________________ (for
wetsuit sizing)
T-shirt Size _________________
CAMPS ONLY
Surfing Experience: Beginning ____________ Intermediate ____________
*All campers must be able to tread
water and swim.
Where did you hear about the camp? Magazine____ Yard Sign____ Flier____
Web Search____
Friend____ Auto Ad____
Desired
¨[ ] April 2-4th
(9:00 AM – 3:00 PM) $250
¨[ ] June 25-28th
(8:00 AM – 2:00 PM) $350
¨[ ] July 9-12th
(8:00 AM – 2:00 PM) $350
¨[ ] July 16-19st
(10:00 AM – 4:00 PM) $350
¨[ ] July 23-26th
(8:00 AM – 2:00 PM) $350
¨[ ] July 30-August 2th
(12:00 PM – 6:00 PM) $350
¨[ ] August 13-16th
(10:00 AM – 4:00 PM) $350
¨[ ] Surf Club (Saturday)
_________________________________________________________
Cost: Includes Transportation, use of Softop Surfboard and Full Wetsuit.
Cost: Includes T-Shirt & In-N-Out Thursday. (camp only)
All Drop-off
and Pick-up will be in the Rite Aid parking lot at McBean and Decoro behind the
Mobil Station.
Parent(s) Name(s)
_________________________________________________________________
Home
Phone_____________________________ Cell Phone(s) ______________________ ______________________
E-mail
_________________________________________
Emergency Name and
Contact ______________________________________________________
Insurance Provider
___________________________________ Policy No. ___________________________
Please mail this form
and make a non-refundable check for $50.00 payable to:
(For surf club you may bring form and payment the day of the event)
John Domke
(661)-993-0340
Upon receipt of
payment, you will receive an e-mail confirmation securing your child’s
placement that you requested.
PARENT’S APPROVAL AND
CAMPER WAIVER
Knowing that surfing is an ocean
sport that may be potentially dangerous and result in possible injury and/or
death, and that some variables may be beyond the control of the said camp and
staff members ___________________________________________ has my (our) our
permission to be
(Name of Minor)
transported to and from and participate in Surf’s Up Surf Camp instruction and
surfing activities from Santa Clarita Valley to
(Dates of Camp)
I (we), as parent(s), or guardian(s)
of the minor, do hereby, for my (our) _________son/daughter_________, myself, my
(our) heir, executors, or administrators, remise, release, and forever
discharge John Domke and Surf’s Up Surf Camp employees and agents of each of
the foregoing, acting officially otherwise, from any and all claims, demands,
actions or causes of action on account of referred.
I hereby certify the minor is my
(our) __________son/daughter__________ and that his/her
date of birth is __________________ and I (we) do hereby certify that to the best
of my (our) knowledge and belief the said minor is in good health. In case of illness or accident, permission is
granted for emergency treatment to be administered. It is further understood that the undersigned
will assume full responsibility for any such action, including payment of
costs. I (we) hereby advise that the
above named minor has had the following allergies, medicine reactions or
unusual physical condition which should be made known to a treating
physician.
(If none, please write the word
“none.”)
My signature also acknowledges that
cell phones, iPods, MP3 Players, digital cameras and other personal items are
brought at the campers own risk and will not be the responsibility of Surf’s Up
Surf Camp if lost, broken, damaged or stolen.
My signature additionally
acknowledges that any improper behavior including the use of alcohol, drugs, or
tobacco is cause for immediate dismissal and no refund will be given.
Allergies, medical reactions or
unusual physical condition
__________________________________ ___________________________________
Parent/Guardian Signature Print Name Date