; SURF CAMP REGISTRATION FORM Eli Howard Surf School
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SURF CAMP REGISTRATION FORM Eli Howard Surf School

VIEWS: 3 PAGES: 2

  • pg 1
									                                                                                                                                    • Surf Camps
                                                                                                                                    • Surfing Lessons
                                                                                                                                    • Private Instruction

                                                                                                                          SURF CAMP REGISTRATION FORM

                                                                                                                    *** PLEASE COMPLETE ALL FIELDS ***
          760.809.3069 • Fax: 760.230.1378 • www.EliHoward.com                                                (we do notsell or give away any studentor client informationunderany circumstances)
                   P.O. Box 232690 • Encinitas, CA 92023


Student’s Name                                                                                Parent or Guardian’s Name (if student is under 18)




Address                                                                                       City                                                 State                Zip




Day Phone                                                                                     Evening Phone




Email Address                                        May we send you promotional email from   Student’s Age                  Student’s Height                   Student’s Weight
                                                           ELI HOWARD SURF SCHOOL?
                                                           (You will receive NO SPAM)

                                                                   YES         NO
Emergency Contact Name:                                                                       Emergency Contact Phone/s:




How did you hear about us?                                                                    Date(s) and Time(s) you wish to sign up for:


                                 INTERNET
                                 RETURNING SURFER!
                                                                                              Overnight Surf Camp: __________________________________________________________________
                                 INTERNET
                                 MAGAZINE

                                                                                              Day Surf Camp (morning): ______________________________________________________________
                                 MAGAZINE
                                 BROCHURE

                                 BROCHUREMOUTH
                                 WORD OF                                                      Day Surf Camp (Afternoon): _____________________________________________________________

                                 OTHER MOUTH
                                 WORD OF________________________
                                                                                                      Escape: _____________________________________________________________________
                                                                                              Weekend Getaway: ____________________________________________________________________
                                 OTHER ________________________
                                                                                              Other Lesson or Class: __________________________________________________________________


Deposit Amount Enclosed (non-refundable):
$50/person Day Surf Camps
$75/person deposit for Weekend Escape
                                  Getaway
$200/person deposit for Overnight Surf Camp
Balance is due at the start of the camp or lesson.



 Ccomments, Special Needs, Medical conditions we should know about:




PLEASE BE SURE TO INCLUDE THE ‘ RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT’                                                                                  WITH THIS FORM
                                                                ELI HOWARD SURF SCHOOL
                                                 RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT
                                                              ELI HOWARD SURF SCHOOL
                                                                (bring this form to the beach)
                                           RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT
This is a release. Read it carefully before signing. This release essentially states that I know I am taking a surfing lesson and will be entering the water at the
                                                               (bring this form to the beach)
beach. As a result of the inherent risks in this activity, I know I may die, get hurt, or damage my belongings. If any of these occur, I understand that I cannot
 This a claim, sue, or expect ELI HOWARD SURF SCHOOL, essentially states that I know I am taking a surfing lesson and of California, it’s Department of
makeis a release. Read it carefully before signing. This releaseits owners, officers, agents, employees, associates, the State will be entering the water at the
 beach. As Recreation (hereinafter referred activity, I know I ELI die, get hurt, or damage my belongings. If responsible or pay understand that I
Parks and a result of the inherent risks in thisto collectively as may HOWARD SURF SCHOOL) to be legally any of these occur, Ifor any damages.cannot make
ACKNOWLEDGMENT AND ACCEPTANCE OF RISKS: I, the undersigned, hereby acknowledge that I have voluntarily chosen to take this surfing lesson and
 a claim, sue, or expect ELI HOWARD SURF SCHOOL, its owners, officers, agents, employees, associates, the State of California, it’s Department of Parks with
 Recreation, the City of Encinitas Certain risks are inherent in any as ELI HOWARD SURF SCHOOL) to be legally responsible or pay for any damages.
ELI HOWARD SURF SCHOOL.(hereinafter referred to collectivelyrecreational activity and cannot be eliminated, altered, or controlled, and these risks that
 ACKNOWLEDGMENT character of the activity RISKS: I, the cause of injury, illness, death, and damages. voluntarily fully understand that surfing is an
contribute to the uniqueAND ACCEPTANCE OF can also be theundersigned, hereby acknowledge that I have I know andchosen to take this surfing lesson
 with ELI HOWARD SURF SCHOOL. Certain risks are with inherent risks and hazards where cannot be eliminated, altered, or controlled, die, sustain injuries
outdoor activity in an uncontrolled natural environmentinherent in any recreational activity andserious accidents can occur, participants canand these risks that
and property damage. character of the activity can also be the cause of injury, illness, death, and damages. I know and fully understand that surfing is an
 contribute to the unique
  acknowledge and uncontrolled natural environment with inherent risks and beach-related activities from the rendezvous until the conclusion of the class
Ioutdoor activity in anwillingly assume all risks and hazards in surfingand hazards where serious accidents can occur, participants can die, sustain injuries
 and property damage.
or lesson, including, but not limited to, (1) loss of control of the surfboard, falls from the surfboard, collision with other participants, equipment, other surf-
 I acknowledge and willingly assume all natural obstacles, in surfing and beach-related activities from the rendezvous until the the instructors, excepting
boards, rocks, and any other man-made orrisks and hazards whether obvious or not; (2) judgment, decision-making and conduct of conclusion of the class or
acts of wanton or gross negligence; (1) loss of control of the surfboard, falls encounters with animals, marineother participants, equipment, other surfboards,
 lesson, including, but not limited to, (3) submersion in water, drowning; (4) from the surfboard, collision with life and insects; (5) exposure to outdoor ocean
environment, extrememan-made or natural obstacles, whether obvious or not; (2) judgment, vehicle in any way related to this activity; (6) assistance in lifting
 rocks, and any other temperatures, sun, and inclement weather, including, travel by foot or decision-making and conduct of the instructors, excepting acts
 of wanton or gross negligence; (3) submersion in water, drowning; unavailability of immediate and appropriate medical attention in case of injury. ocean
and/or carrying surfing equipment; (7) rescue-related injuries; and (8) (4) encounters with animals, marine life and insects; (5) exposure to outdoorI under-
 environment, extreme temperatures, sun,
                                               is not complete or exhaustive, and that by foot or known or unknown, anticipated activity; (6) assistance in exist
stand and acknowledge that the above list and inclement weather, including, travelother risks,vehicle in any way related to thisor unanticipated, may alsolifting
 and/or carrying surfing equipment; (7) rescue-related injuries; and (8) unavailability of immediate and appropriate medical attention in case of injury. I understand
and result in injury, illness, disease, death or damage. My participation in this activity is purely voluntary and I elect to do so at my own risk.
 and acknowledge that the above list is not complete or exhaustive, and that other risks, known or unknown, anticipated or unanticipated, may also exist and
RELEASE: In consideration for death or damage. My participation in this activity is purelythis class orand I elect to do so agree to release, discharge, and
 result in injury, illness, disease, ELI HOWARD SURF SCHOOL allowing me to participate in voluntary lesson, I voluntarily at my own risk.
 RELEASE: In consideration for any and all claims of SCHOOL allowing me to negligence, this recklessness, I any other agree to release, discharge, and
hold harmless ELI HOWARDfor ELI HOWARD SURF liability arising out of theirparticipate in fault,class or lesson,or voluntarily act or omission which causes the
 hold harmless ELI HOWARD for any and all claims of liability arising out any way connected with my participation any other act or omission which causes the
undersigned illness, injury, disease, death, and damages of any nature inof their negligence, fault, recklessness, or in this surfing activity. I also expressly agree
 undersigned illness, injury, disease, death, and damages of any any act any way connected with my participation gross negligence, in rendering or failing to
to release and discharge ELI HOWARD SURF SCHOOL from nature inor omission, excluding acts of wanton or in this surfing activity. I also expressly agree
 to release type of rescue, emergency SURF SCHOOL from any act or omission, excluding acts of wanton or gross negligence, in rendering minor on render
render anyand discharge ELI HOWARDor medical services. In signing this document, I fully recognize and understand that if I (or anyor failing to whose
 any type of signing this release) am hurt, die, or signing this is damaged, I am giving up my right to make a claim or file a lawsuit against ELI
behalf I amrescue, emergency or medical services. Inmy property document, I fully recognize and understand that if I (or any minor on whose behalf I
 am signing this release) am hurt, if they negligently is by some I am act or omission, to make a acts or file a lawsuit against ELIHOWARD SURF
HOWARD SURF SCHOOL, even die, or my property or damaged,othergiving up my right excludingclaim of wanton or gross negligence, cause the
injury or damage.they negligently or by some other act or omission, excluding acts of wanton or gross negligence, cause the injury or damage.
 SCHOOL, even if
   further agree, to hold harmless, defend, and indemnify ELI HOWARD SURF SCHOOL from defense costs, including attorney’s fees incurred in in connec-
IIfurther agree, to hold harmless, defend, and indemnify ELI HOWARD SURF SCHOOL from allall defense costs, including attorney’s fees incurredconnection
 with claims for for bodily injury, wrongful death, or property damage which I sustain, or which is, sustained by any minor under 18 years of age on whose
tion with claimsbodily injury, wrongful death, or property damage which I sustain, or which is, sustained by any minor under 18 years of age on whose behalf I
 am signing, or which I, or the minor on whose whose behalf I am signing, may have caused to spectators or other third parties, whether negligent or not,
behalf I am signing, or which I, or the minor onbehalf I am signing, may have caused to spectators or other third parties, whether negligent or not, in the course
 of my participation participation
in the course of myin this activity.in this activity.
 As parent or legal guardian of a participant under 18 years of age, have read and voluntarily agree that said minor may participate in this surfing lesson or
As parent or legal guardian of a participant under 18 years of age, II have read and voluntarily agree that said minor may participate in this surfing lesson or
 class, and sign this release on their behalf and on the behalf of the minor’s parents and/or legal guardians. In addition, give ELI HOWARD SURF SCHOOL
class, and IIsign this release on their behalf and on the behalf of the minor’s parents and/or legal guardians. In addition, II give ELI HOWARD SURF SCHOOL
 permission to treat said minor in case of illness, injury, emergency, or accident. Should emergency medical services become necessary, for the undersigned
permission to treat said minor in case of illness, injury, emergency, or accident. Should emergency medical services become necessary, for the undersigned
 participant or minor, the expenses are the sole responsibility of the participant and not that of ELI HOWARD SURF SCHOOL. Personal medical insurance
participant or minor, the expenses are the sole responsibility of the participant and not that of ELI HOWARD SURF SCHOOL. Personal medical insurance
 is strongly advised for all participants.
is strongly advised for all participants.
 ELI HOWARD SURF SCHOOL reserves the right to accept or deny service to any person. I hereby agree to follow all rules, regulations, and instructions of ELI
ELI HOWARD SURF SCHOOL reserves the right to accept or deny service to any person. I hereby agree to follow all rules, regulations, and instructions of ELI
 HOWARD SURF SCHOOL while participating in this class or lesson. I also certify that I and any minor on whose behalf I am signing, are physically and mentally
                                                                                also certify HOWARD SURF SCHOOL of any pertinent signing, are physically and
HOWARD SURF SCHOOL while participating in this class or lesson. Iinformed ELI that I and any minor on whose behalf I am medical conditions that may
 capable of participating in these activities. I hereby represent that I have
mentally capable of participating in these activities. I hereby represent that I have informed ELI HOWARD SURF SCHOOL of any pertinent medical conditions
 affect my or the minor’s participation in these surfing activities. I hereby agree that ELI HOWARD SURF SCHOOL may use film or photographic records of this
that may affect my or the minor’s participation in these surfing activities. I hereby agree that ELI HOWARD SURF SCHOOL may use film or photographic
 surfing class or lesson for its promotional and/or commercial purposes without compensation to me.
records of this surfing class or lesson for its promotional and/or commercial purposes without compensation to me.
 The venue of any dispute that may arise out of this agreement or otherwise between the parties to which ELI HOWARD SURF SCHOOL or its agents is a party
 shall be San any dispute that
The venue of Diego County. may arise out of this agreement or otherwise between the parties to which ELI HOWARD SURF SCHOOL or its agents is a party
shall be San Diego County.
 I HAVE READ THIS DOCUMENT IN ITS ENTIRETY. I UNDERSTAND THAT I AM ASSUMING ALL THE RISKS INHERENT IN THIS SURFING ACTIVITY.
    UNDERSTAND THAT IT IS A RELEASE OF ANY I UNDERSTAND THAT I AM ASSUMING ALL THE THE INHERENT IN THIS SURFING ACTIV-
IIHAVE READ THIS DOCUMENT IN ITS ENTIRETY. AND ALL CLAIMS. I UNDERSTAND THAT THIS ISRISKSENTIRE AGREEMENT BETWEEN THE
ITY. I UNDERSTAND THAT IT IS A RELEASE OF ANY AND ALL CLAIMS. I UNDERSTAND THAT THIS IS THE ENTIRE AGREEMENT BETWEEN THE
 UNDERSIGNED AND ELI HOWARD SURF SCHOOL, THEIR OWNERS, OFFICERS, AGENTS, AND EMPLOYEES, AND THAT IT CANNOT BE MODIFIED
 OR CHANGED AND ELI HOWARD SURF SCHOOL, THEIR OR STATEMENTS BY ELI HOWARD SURF SCHOOL OR BY THE UNDERSIGNED. I
UNDERSIGNEDIN ANY WAY BY THE REPRESENTATIONS OWNERS, OFFICERS, AGENTS, AND EMPLOYEES, AND THAT IT CANNOT BE MODI-
 VOLUNTARILY SIGN MY NAME AS EVIDENCE OF MY ACCEPTANCE OF ALL THE PROVISIONS IN SURF SCHOOL OR BY THE UNDERSIGNED.
FIED OR CHANGED IN ANY WAY BY THE REPRESENTATIONS OR STATEMENTS BY ELI HOWARD THIS RELEASE AND MY AGREEMENT TO BEI
 BOUND BY THEM.
VOLUNTARILY SIGN MY NAME AS EVIDENCE OF MY ACCEPTANCE OF ALL THE PROVISIONS IN THIS RELEASE AND MY AGREEMENT TO BE
BOUND BY THEM.
 Name of participant                                                                           Day Phone                                            Evening Phone




 Address                                                                                       City, State, Zip




 Email Address
                                                                                                                  Check here if you DO NOT wish to receive an occasional email from us



 Are you over 18 years of age?       Yes                                                                                                            Class Date
     No - Accompanying adult must sign and date here:



 Signature (If participant is under 18 parent or legal guardian must sign here)*                                                                    Today’s Date




*Minors not accompanied by their parent must bring this form signed by their parent or legal guardian. Adult accompanying the minor must also sign this release as a verification of the parent/
guardian signature. Please bring this form to the beach.

								
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