Ventura Surf School  Logo - Tel. (805) 649 3710

 

Tel: (805) 218 1484

Fax: (805) 985 1220

email:

Ventura Surf School
607 W. Channel Islands Blvd.
Port Hueneme, CA
93041

www.venturasurfschool.com

2008 ADULT SIGN-UP FORM - Please print and mail or FAX.

Private lessons $100 for two hour lesson.
Group lessons $75 per person for two hour lesson.

First Name:

 

Last Name:

 

Address:

 

City:

 

State & Zip:

 

 

 

Age:

 

Home Phone:

 

Work Phone:

 

Mobile Phone:

 

E-mail Address

 

Emergency Contact:

 

Doctor:

 

Doctor Phone:

 

Health Insurance Policy #:

 

Any health
problems?

 

Swimming Ability
(Circle One)

Beginner

Intermediate

Advanced

Surfing Ability
(Circle One)

Beginner

Intermediate

Advanced

Want a T-Shirt?
$15 each

Small

Medium

Large

X-Large

 

If you need to borrow a wetsuit?
What's your:

Height Weight

How did you hear about
Ventura Surf School?

 


Credit Card Number

 

Credit Card Expiration Date

Name on Credit Card

 

We also offer kids' birthday parties and private lessons for all ages.

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RELEASE FROM LIABILITY and ASSUMPTION OF RISK

 

I, the undersigned, hereby acknowledge that the activity of "Surfing" to be performed by my person is a sporting activity which by its own nature is a hazardous physical activity on the beaches and waters of the Pacific Ocean involving risk of serious injury and/or death, and I am voluntarily participating in these activities with knowledge of the dangers involved and I hereby agree to accept any and all risks of injury or death.

For and in consideration of the participation in the Ventura Surf School, I do hereby for myself, executors, and administrators, agree to forever waive, release, acquit, discharge, and hold harmless, the Ventura Surf School, County of Ventura, City of Ventura, County of Santa Barbara, City of Santa Barbara, City of Carpinteria, State of California, and its successors, principals, officers, employees, volunteers, servants, and agents from any and all liability, rights, damages, claims, actions, costs, loss of service, expense and compensation, on account of or in any way arising from any and all known or unknown personal injuries and property damage, which we may have before or after reaching the age of majority, and resulting from the aforementioned surfing activity and the collateral activities of the Ventura Surf School pertaining thereto.

Date:

 

Print Name:

 

Signature:

 



In the event of a medical emergency, I give my consent for medical treatment that may be necessary.

Date:

 

Print Name:

 

Signature:

 


Any Questions?
Call: (805) 218 1484

E-Mail:


Home:
www.venturasurfschool.com

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