Welcome to Fitness your source f

Date
Surfer First Name		Surfer Last Name
Parent/Guardian
Address
City		State & Zip
Home Phone	Work Phone		Cell Phone
Email Address

Emergency Contact __________________________________ Phone ___________________________

Surfer Gender: _____ male _____ female Surfer Age: _____

Date(s) requested for lesson______________________________________________

Any health problems?
Allergies / Medication
Swimming Ability (circle one)	Beginner		Intermediate		Advanced
Surfing Ability (circle one)	Beginner		Intermediate		Advanced
If you need to borrow a wetsuit, what’s your?		Height		Weight
How did you hear about Silver Strand Surf Instruction?

Release from Liability and Assumption of Risk Agreement

We, the undersigned, hereby acknowledge that the activity of “Surfing” to be performed by my person is a sporting activity which by its own nature is a hazardous physical activity on the beaches and waters of the Pacific Ocean involving risk of serious injury and/or death, and I am voluntarily participating in these activities with knowledge of the dangers involved and I hereby agree to accept any and all risks of injury or death.

For and in consideration of the participation in the Silver Strand Surf School, I do hereby for myself or we the undersigned, the father and mother and/or guardian of the said participant, a minor, do hereby for ourselves, executors, and administrators, agree to forever waive, release, acquit, discharge, and hold harmless, Silver Strand Surf School, County of Ventura, City of Ventura, City of Oxnard, State of California, and its successors, principals, officers, employees, volunteers, servants, and agents from any and all liability, rights, damages, claims, actions, costs, loss of service, expense and compensation, on account of or in any way arising from any and all known or unknown personal injuries and property damage, which we may have before or after reaching the age of majority, and resulting from the aforementioned surfing activity and the collateral activities of Silver Strand Surf School pertaining thereto.

I have read this document in its entirety. I understand that I am assuming all risks inherent in this surfing activity. I understand that it is a release of any and all claims. I understand that this is the entire agreement between the undersigned and Silver Strand Surf School, their owners, officers, agents and employees, and that it cannot be modified or changed in any way by the representations or statements by Silver Strand Surf School or by the undersigned. I voluntarily sign my name as evidence of my acceptance of all the provisions in this release and my agreement to be bound by them.

Date	Print Name
Participant Signature
We the undersigned hereby acknowledge to be the lawful parents and/or guardian of the above mentioned minor and we therefore, acknowledge our qualifications to sign the subject agreement on behalf of the said minor.
Date	Print Name
Parent/Guardian Signature
In the event of a medical emergency, I give my consent for medical treatment that may be necessary.
Date	Print Name
Participant/Parent/Guardian Signature

Pricing

§ Private Lessons $100 for 2 hours

§ Semi Private (2 –3 people) $75 per person for 2 hours

§ Group Lessons $60 per person for 2 hours (4 –12 people)

§ Surf Camp $275 for one week, Mon-Fri, 9:00am to1:00 pm

Payment & Terms

A non-refundable 50% deposit is due when the surf lesson is scheduled. The balance is due the day of the surf lesson. For Kids Camps Full payment is due 48 hours prior to start date. Cash, check and Credit card is accepted for payment. A 48-hour cancellation – re-schedule notice is required. Please call 805.985.7867 For questions or concerns.