Lesson & Clinic Registration Form

This registration form and the release form must be completed. The release form must be printed, completed and delivered to Soul Surfing School.

Contact Information

Student Name

# of Students in Group

(Fill in group information below)

Referral Resort/Hotel

(if applicable)

Home Address

Home City

Home State

Home Zip

Home Phone

(format=949-123-4567)

E-mail

(format=user@domain.com)

Re-Enter E-mail

(format=user@domain.com)

Birth Date

Month: Day: Year (YYYY)

Student/Group Information

We need the following information from ALL prospective students in your group in order to make your lesson the best it can be. Be sure to purchase the correct number of lessons for the amount of students in your group.

Student 1

Name	Age	Height	Weight
Experience Level			Gender

Student 2

Name	Age	Height	Weight
Experience Level			Gender

Student 3

Name	Age	Height	Weight
Experience Level			Gender

Student 4

Name	Age	Height	Weight
Experience Level			Gender

Student 5

Name	Age	Height	Weight
Experience Level			Gender

Lesson Times and Dates

Please fill out the following section to indicate the desired date(s) of your lesson. Lesson times are dependent on ocean tides and conditions. Please email info@soulsurfingschool.com to arrange the time of your lesson.

Schedule your Private Lesson(s):
Date(s) Backup Date(s)
Schedule your Group Lesson(s):
Date(s) Backup Date(s)

Agreement

This form and the release form signed and returned.

I certify that I or my child is qualified to swim in the ocean and understand that any violation of rules set forth by "Rules of the Beach" on my part or on the part of my child will be due cause for me or my child's immediate dismissal from this school with NO REFUND. I also understand that any deposit and/or tuition is "NOT REFUNDABLE". I acknowledge that I have read and understand all of the above.

In addition, all pictures taken at camp can be used to promote camp through advertising. In the event of a beach closure, all water activities will be restricted until the State Park authorities provide the camp management with the all clear to re-enter the water.

Payment Information

Payment Information: Please send check or money order to:
Soul Surfing School
255 Oak St, Laguna Beach, Ca. 92651
or for credit cards use PAYPAL on Pricing page.

Be sure to purchase the correct number of lessons for the amount of students in your group.