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SURF CAMP REGISTRATION FORM

STEP ONE:
Please provide the following information:
Asterisk (*) fields are required. Please provide as much information as possible so we can better take care of you!

Personal Information:

* First Name
* Last Name
*Age
Gender	Male Female
* Parent/Guardian Name

* Primary Phone (Preferably Cell)
Secondary Phone (Home/Work/etc.)
* E-Mail Address
Street Address
Address 2 (Apt/Suite)
City
State
Zip Code

* Emergency Contact (Name)
* Emergency Contact (Phone)
Physician Name
Physician Phone

Please let us know of any medical conditions you may have that would require
any special assistance? If none please leave blank:

Camp Info:

*Primary Date of Camp Requested
Second Week of Camp Requested
Third Week of Camp Requested
*Type of camp requested
*Location of camp requested

Note: Trial days are on Mondays only.
If attending more than 3 weeks of camp, please indicate
additional weeks in the comments section.

Wetsuit:

* Please select size, or select "I will bring my own."

If the wetsuit sizes listed do not match your height and weight, please select the most approximate size and make a note of your height and weight in the comments field.

Size chart

Size	Height	Weight
4	4' 1 - 4' 3	30-40
6	4' 3 - 4' 5	45-60
8	4' 5 - 4' 7	60-75
10	4' 7 - 4' 10	75-90
12	4' 10 - 5' 1	90-105
14	5' 1 - 5' 5	105-120
XS	5' 5 - 5' 7	120-140
S	5' 7 - 5' 9	135-155
M	5' 9 - 5' 11	150-170
L	5' 11 - 6' 1	170-185
XL	6' 1 - 6' 2	185-210
XXL	6' 2 - 6' 3	210-230
XXXL	6' 3 +	230-250

Additional Children:

Name	Age	Wetsuit Size	Relationship to Registrant
			Sibling Friend/Other
			Sibling Friend/Other
			Sibling Friend/Other

Early Drop-off and Late Pick-up are available at a rate of $15 per child per hour

Early Drop-off (9:00 am)	Mon Tue Wed Thu Fri
Late Pick-up (4:00pm)	Mon Tue Wed Thu Fri
If Paying by Gift Certificate, Enter Number Here
Referral/Coupon Code
How'd you hear about us

Additional Info/Comments:

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