(714) U-Go-Surf
Seal Beach, CA (714) 846-7873
Participant Name: ______________________________ Parent/Guardian Name:___________________________________
(Required for anyone under 18 years of age.)
Phone No.: ________________________________ Parent/Guardian Cell No. _____________________________________
Address: ____________________________________________________ Participant Birth Date: ______________________
City: ___________________________________________________________________________________________________
State: _______________ Zip: ______________ Email Address: ____________________________________________
Each participant must have a separate, signed, registration form prior to the first class. For multiple registrations, fill out one form with similar information, make a copy, and then fill out unique information for each student.
___ Semi-Private Hourly - $80.00 per hour
___ Surf Camp Weekly (year round) - $250.00 for 5 days, Mon-Fri - 8am - 2pm (Summer) 8am - noon (Winter)
Sat-Sun - 8am - noon
(circle days) M T W Th F Sat Sun
___ Special Occasion - Call/email for pricing
Comments: (please let us know how you found M&M Surfing School) ______________________________________________
Emergency Contact: ______________________________ Emergency Phone:_____________________________________
Allergies, current medications, and/or pre-existing medical conditions: (please describe below)
________________________________________________________________________________________________________
By signing below, I acknowledge that I have read and understand this release form.
Participant or Parent/Guardian: __________________________________________________ Date: ___________________