Email Address
Important information regarding your lesson may be sent to this email address!
Please use an email account you check frequently!

Select Lesson Date(s)
Only dates with availability are listed.

Mon June 27th, 2011 Tue June 28th, 2011 Wed June 29th, 2011 Thu June 30th, 2011 Fri July 1st, 2011 Mon July 4th, 2011 Tue July 5th, 2011 Wed July 6th, 2011 Thu July 7th, 2011 Fri July 8th, 2011

Mon July 11th, 2011 Tue July 12th, 2011 Wed July 13th, 2011 Thu July 14th, 2011 Fri July 15th, 2011 Mon July 18th, 2011 Tue July 19th, 2011 Wed July 20th, 2011 Thu July 21st, 2011 Fri July 22nd, 2011

Mon July 25th, 2011 Tue July 26th, 2011 Wed July 27th, 2011 Thu July 28th, 2011 Fri July 29th, 2011 Mon August 1st, 2011 Tue August 2nd, 2011 Wed August 3rd, 2011 Thu August 4th, 2011 Fri August 5th, 2011

Mon August 8th, 2011 Tue August 9th, 2011 Wed August 10th, 2011 Thu August 11th, 2011 Fri August 12th, 2011 Mon August 15th, 2011 Tue August 16th, 2011 Wed August 17th, 2011 Thu August 18th, 2011 Fri August 19th, 2011

Your Information
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Gender Male Female

Parent Information
If you are under 18 years of age, you must provide this information. Otherwise, leave blank.

Emergency Contact Information
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Medical Information
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Please list any relevant health concerns. E.g., allergies, medical conditions

Please list any medications that may be required

Surf Experience
This information is helpful but not required.

I have... Never Surfed Tried surfing a few times Taken a surf lesson from Surf Camp Aprox. size for wetsuit XS S MD LG XL

Additional Information
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Is there any other information we should be aware of?

How Did You Hear About Surf Camp
Helpful, but not required.

Please Choose Taken a lesson in the past Heard from a friend Online Newspaper ad Flyer or brochure Summer Camp guide Surf Shop Other