Learn to Surf LA - Surf Lesson Registration

SURF LESSONS REGISTRATION FORM

Step 1:
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
Gender	Male Female
*Primary Phone (Preferably Cell)
Secondary Phone (Home/Work/etc.)
Street Address
Address 2 (Apt/Suite)
City
State
Zip Code
Emergency Contact (Name)
Emergency Contact (Phone)
Please let us know of any medical conditions you may have that would require any special assistance? If none please leave blank:
Confirmation Info: We will email a confirmation to each email address you provide below.
* E-Mail Address
Alt/2nd E-Mail Address
Alt/3rd E-Mail Address

Lesson Info:

* Number of Students	Total $
* Number of Lessons	Pricing & Discounts
* Type of lesson

Summer Schedule:

Private Lessons available daily between 8am and 6pm
Adult Progressive Group Lessons available at 8am on weekends at our Dockweiler location, and at 2:15pm daily at our Santa Monica location.

Winter Schedule:

Private Lessons available daily between 8am and 4pm
Adult Progressive Group Lessons only available at 10am on Saturdays at our Santa Monica location.

* Date requested
Alt/2nd date requested
Alt/3rd date requested
4th date requested
5th date requested
6th date requested
7th date requested
8th date requested
9th date requested
10th date requested

NOTE: We will confirm date(s) and time(s) requested
if available or suggest alternatives if not.

Location:

*Location requested

Wetsuits:

Please enter the quantity for each size needed.
NOTE: If the wetsuit sizes listed do not match your height and weight, please select the most appropriate size for your weight and make a note of your
height and weight in the comments field below.

Quantity	Size	Height	Weight (lbs)
	Own	Student will bring their own wetsuit(s)
	4	4' 1" - 4' 3"	30 - 45
	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' 2" - 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