Surf Camp Registration

Participants Full Name*

Parents Name*

Parents Email*

Parents Phone*

Dietary Requirements*

None

Vegetarian

Gluten Free

Vegan

Halal

Lactose Free

Diabetic

Nut Free

Celiac

Other - Please detail below

Other/ any dietary details

Allergic - please provide details

Anaphylactic - please provide details - Please send ASCIA Plan

Medical Conditions*

None

Heart Condition

Breathing Condition

Asthmatic

Other - please list

Swimming Ability*

Non Swimmer - Cannot swim and partake in water activities

Beginner - Can swim with assistance of flotation aid

Strong Swimmer - Can comfortably swim 50-100m

I agree to the terms and conditions outlined in the RISK WARNING, WAIVER AND EXCLUSION OF LEGAL LIABILITY FOR PARTICIPANTS - view here

Name of Participant*

Name and address of parent, guardian or person performing parental responsibilities for Participant*

Date of Birth and Age of Participant*

Age*

Emergency Contact Name (must be over 18 years of age) and Relationship to Participant*

Emergency Contact Phone Number*

Signature*

Date of Signature*

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