On-Line Surf Lesson Registration 2012

We Are Coaches, Inc.

Aqua-Adventures

Private Surf Lesson

(Download printable version - pdf)
(Download printable version - word)

Submit this form or mail a printable version and make checks payable to:
We Are Coaches, Inc. 2945 Cape Sebastian Place, Cardiff, CA 92007
Or phone in Visa/MC payment information
Call Peg Windisch (760) 436-1514
We will call or e-mail to confirm enrollment.

How did you find us?

Parent/Guardian Info
Last: First:
Address:
City: State: Zip:
email:
Home Phone: Work Phone: Cell Phone:

Student Info
Last: First:
Gender Age Current Grade Height Weight
(lbs)		 Swim Skill Can Swim 200 yds Surf Skill
 M F
 ft. in.
 Yes No
Other:

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Lesson Details
Lesson Day: Lesson Date: Start Time: End Time:
Location Preferences
1st: 2nd:
Have you taken lessons or attended camp with us before?
 Yes No

Equipment Needs
Surfboard:
 Yes No
 Size: Wetsuit:
 Yes No
 Shirt Size:

Cancellation Policy
  • A $100 deposit is required to confirm a lesson date and location. Complete payment is due on the day of the lesson.
  • A full refund will be issued for any program canceled by We Are Coaches, Inc. Activities are subject to change. $50 PROCESSING FEE IS CHARGED FOR EACH CANCELLATION
  • If you cancel less than ten (10) working days before the activity starts you will not receive a refund. Refunds take 2-3 weeks to process.
By checking this box I acknowledge I have read and understand the cancellation policy.

Photo Release
 Yes No
 I give permission to use my child's photos in We Are Coaches marketing material

Release From Liability and Indemnification
Please read and acknowledge the following by checking the checkbox. The form will not submit without this acknowledgement.
I certify that I am a parent or a guardian of [Student Listed above] and intend to enroll him/her in the above referenced activity. On behalf of myself and my child I agree to waive and release We Are Coaches, Inc. and its officers, agents, and employees, from and against any and all claims, cost liabilities, expenses, or judgments, including attorney’s fees and court costs arising out of my child’s participation in this program or any illness or injury resulting there from except injury deliberately or willfully caused. I understand that if my child is injured this waiver will be used against me and anyone else claiming damage because of my child’s injury in any legal action. I agree that pictures taken during program hours may be used for future promotional purposes. I also understand that no employee or agent is authorized to modify this waiver.

Emergency Medical Release
Please read and acknowledge the following by checking the checkbox. The form will not submit without this acknowledgement.
In the event of sudden illness, accident or injury which may occur while said minor is engaged in activity supervised by the representatives, agents or assignees, when neither the parents, guardian or designated family physician can be contacted, I hereby give my consent pursuant to California Civil Code #25.8 for emergency treatment as shall be necessary under circumstances by any physician licensed under the Laws of the State of California and release and discharge We Are Coaches, Inc. and agents, or employees from any and all claims for personal injury.

Medical Information

Family Physician: Phone:
Insurance Company: Type of Coverage:
Pertinent medical History
(Epilepsy, diabetes, allergies, etc.)
Emergency Phone: