_____ Session 1 (9 am-1pm) _____ Session 2 (1pm-5pm)

How did you hear about our camps? _______________________________________________________________________________________

Will you be needing a soft surfboard? _____Yes _____ No

Level: _____ Beginner     _____ Intermediate        _____ Advanced

Camper’s Name: _________________________________________________________________________

Age: ____________                     _____ Male        _____ Female

Address: _______________________________________________________________________________

City: ___________________________________________ State: _______ Zip Code: _________________

Parent(s) Name: _________________________________________________________________________

Home Phone: ______________________________ Work/Cell Phone: ______________________________

E-mail Address (IMPORTANT): ____________________________________________________________

List any medical problems, allergies, medications, etc.: ___________________________________________

________________________________________________________________________________________

Who else may we contact in an emergency?

Name: _____________________________________________ Phone: ______________________________

I, the undersigned, being the parent, legal guardian or person in charge of the above named minor participant, in consideration of being permitted to participate in the surf camp program, do hereby give permission for said minor to participate and do release any sponsors, camp instructors, employees, agents of the Carlsbad Unified School District, and the City of Oceanside of any and all liability or responsibility arising from any injury received or incurred by participation in this program or its activities. I further understand that water activities are dangerous and accidents can happen. I also understand that my child must be a capable swimmer and is prepared to participate in ocean water activities. I also give permission for the camp director to make any emergency decision needed for the safety of my child. It is also understood that jellyfish, stingrays, seaweed, etc. are all part of the oceans hazards and will not hold any of Coach Cooper’s Surf Camp personally liable for stings, bites, etc. I further understand that there are NO REFUNDS given except in the event that Coach Cooper’s Surf Camps cannot provide its services. Any pictures taken during the camps may be used in future publications for Coach Cooper’s Surf Camps. I also understand that weather and water conditions can vary and Coach Cooper’s Surf Camps are not responsible for poor conditions. My child will be sent with proper sun protection such as hats, sunscreen, etc. Coach Cooper’s Surf Camps are NOT responsible or liable for any items stolen or lost while at surf camps. With this signature I also certify that my child is a capable swimmer and feel comfortable with them in the ocean water.

__________________________________________________________ _________________________
Signature of Parent/Legal Guardian                      Date