Surf Camp Registration

Surf Camp Registration Form

Your Contact Information

( Please fill in all fields.)

Name:

First Last

Address

Street1 Street2

City State/Province

Zip or Postal Code Country

Phone

date of birth

Year:

Email *

Have you ever been to Richard Schmidt Surf Camp or lesson before?

Yes No

If yes, has your contact information changed since you last participated in one of our surf camps or lessons?

Yes No

Surf Camp Info

Lesson / Camp

Please select your preferred lesson or camp date.

Start date:

Promo Code

Surf Experience

First-Timer Beginner Intermediate Advanced

Gear

Will you need a wetsuit?       Yes      No

Gender:    Male        Female

If yes, what is your height?       feet and inches
What is your weight?    pounds

T-Shirt size:       Small       Medium       Large       Extra-Large

   What is your preferred board type?

Where did you hear about our surf camp?

Website
Brochure
Surf Shop/Retailer
Friend/Family
Taken an RSSS lesson or surf camp before
Web search
Link from other site
Other:

Emergency Contact Info

Person to Contact

Name Phone

Please list any food restrictions, allergies, or medical conditions we should be aware of:

Do you carry insurance? Yes No

If yes, name of insurance company:

Medical Permission

For
Campers under
18 years old

Required if participant is under 18 years of age

In case pf emergency and parent or guardian cannot be reached, call:
Name Phone

This is to certify that if should become ill or have an accident requiring emergency medical care, and if the parent or guardian cannot be contacted, the camp director has permission to authorize such action as he/she deems necessary.

Parent's Declaration: To the best of my knowledge, this camper has not been exposed to any contagious or infectious diseases during the past 3 weeks. I give my permission for this camper to engage in all camp activites except those listed below.

Restricted Activites:

I have read and agree to the above medical permission statement.

Surf Camp Policy

The following are Richard Schmidt Surf Camp's policy on the use of narcotics and undesireable behavior. Please read and sign the following with your child.

•  Surfing is a good, clean, healthy sport. Anyone caught using
    alcohol, tobacco or drugs will be sent home immediately.

•  Surfing teaches us how to respect the environment, ourselves and others.
    Any theft, bodily harm to other people or their property will not be tolerated.


I, the parent, have read the above paragraph and agree that I will require
         my child to abide by the surf camp policies.

I, the camper, have read the above paragraph and agree to abide by the
         surf camp policies.

Submission

Today's Date

(Please use MM/DD/YY format)

Additional
Info You
Need Us TO
Know

Any problems with this form, or just need more info,
please email Richard Schmidt Surf School.