RANCHO DEL MAR SURF CAMP REGISTRATION FORM

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RANCHO DEL MAR SURF CAMP REGISTRATION FORM Powered By Docstoc
					   RANCHO DEL MAR SURF CAMP REGISTRATION FORM
                        Return Registration Form and Payment to:
                                       Kelise Ward
                                       PO Box 314
                                    Del Mar, Ca, 92014
                                   Phone: 858-775-0901
                        Email: kelise@ranchodelmarsurfcamp.com
                         Web: www.ranchodelmarsurfcamp.com

Child’s Name___________________________________
Address________________________________________
City______________________ State______Zip________
Age_________Sex____________

Parent or Guardian Information
(If same as above leave blank)
Address_________________________________________
City ______________________State______ Zip________
Home Phone___________________
Cell Phone_____________________
Email_________________________

Emergency Information
Please list the persons, other than parents, who can be called in
case of an emergency.
Name__________________________ Phone________________ Relationship______________________
Please list the persons who are authorized to pick up your child from camp.
Name__________________________ Relationship______________________
Health Information
Please list any allergies or medical conditions your child has.
_______________________________________________________________________
Please list any medication your child is currently taking.
_____________________________________________________________________________________
Family Doctor___________________________________
Address________________________________________
Phone__________________________________________


Please check the week(s) that your child would like to attend
Rancho Del Mar Surf Camp
Dates
June 16-19, 2008_____________
June 23-26, 2008_____________
June 30 – July 3, 2008____________
July 7-10, 2008_____________
July 14-17, 2008____________
July 21-24, 2008____________
July 28 –31, 2008___________
August 4-7, 2008___________
Aug 11-14, 2008_________
August 18-21, 2008__________
August 25-28, 2008__________

FEES
Daily: $85.00
Weekly: $340.00

To ensure that your child has a place in camp,
please send payment in full with registration and liability form one week in advance to:
Kelise Ward
PO Box 314
Del Mar, Ca, 92014

Payment Methods: Cash, Check, or Money Order

How did you hear about us?
________________________________________________________________________

Child’s Name__________________Parent Signature___________________Date_______

				
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Lingjuan Ma Lingjuan Ma MS
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