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?

   

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

    

 
    Surf Camp Info
  
Lesson / Camp 		    
Please select your preferred lesson or camp date.

Start date:  
  
  
Promo Code   #
Surf Experience  
  
Gear		     
Will you need a wetsuit?       

      feet and inches
What is your weight?    pounds

T-Shirt size:                        
   

   

   
   What is your preferred board type?
  
   

  
Where did you hear about our surf camp?








  
    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?         

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.