Fax or Mail Application along with a deposit of $200 to - PO BOX 414, San Clemente, CA 92674
First Name
 		Last Name
 Street Address
Apt #           City
        
Zip
E-mail
Other Country
Phone
Cell Phone
   		  
Age:   Height: ' "   Weight:
T-Shirt Size: XS S M L XL
Have you ever surfed before? YES NO (NO PREVIOUS EXPERIENCE REQUIRED)
If yes, what is your surfing ability: 
BEGINNER (Riding the white water)
INTERMEDIATE (Riding the open face of the wave)
ADVANCED (Turning on the open face)
Will you be bringing your own wetsuit? YES NO
Will you be bringing your own Surfboard? YES NO
How did you here about us? Other:
PLEASE SELECT A PACKAGE
*Sessions 1,2,14, and 15 are scheduled as adult only 5 day camps (18 years and older).
**Sessions fill fast so reserve your space early, please list a second choice in case your first choice is full.

OVERNIGHT SURF & TURF PACKAGE - $1,195





» 5 day overnight surf & turf camp session
» Accomodations provided at our scenic campsite
» All meals
» Surfing/Golf instruction and equipment


DAY SURF & TURF PACKAGE - $595





» 5 day, day only surf camp M-F 8am-3pm
» Lunch, snacks and drinks provided
» Surfing/Golf instruction and equipment
» *Accomodation not provided


 

FLIGHT INFORMATION - for overnight campers only
Airport of arrival/departure  Airline Flight #
Arrival Date:   Arrival Time: AM PM

NOTE: If you don't have your flight information yet and wish to apply now you can mail, fax, or email your itinerary when convenient.
PAYMENT INFO - Money Order/ Check make payable to:
Endless Summer Surf Camp
PO Box 414
San Clemente, CA. 92674

Fax applications to: 949-388-0193 		Credit Card Payment:
VISA Mastercard

Credit Card #


Expiration Date
Charge full amount to credit card

Only charge $200 deposit and charge remaining balance 14 days prior to arrival
$200 RESERVES YOUR SPACE. THE REMAINING BALANCE DUE 14 DAYS PRIOR TO ARRIVAL
EMERGENCY INFORMATION
Name:    Insurance Company:   Policy #:
IN CASE OF EMERGENCY, PERSONS WHO MAY BE CONTACTED AND TO WHOM INDIVIDUAL MAY BE RELEASED:
Mother/Guardian:    Phone:

Father/Guardian:     Phone:
IF THE ABOVE PERSONS CANNOT BE REACHED, WE CAN CONTACT AND OR RELEASE THE INDIVIDUAL TO:
Relative/Friend:   Phone:

Relative/Friend:   Phone:
SHOULD A SERIOUS INJURY OR ACCIDENT OCCUR AND WE ARE UNABLE TO CONTACT THE PARENTS AND/OR FAMILY PHYSICIAN, PERMISSION IS HEREBY GRANTED FOR MEDICAL CARE TO BE GIVEN AS REQUIRED. THE UNDERSIGNED PARENT OR GUARDIAN IS RESPONSIBLE FOR ANY FEE INVOLVED.
Parent/Guardian: _________________________   Date:
DOES THE PARTICIPANT HAVE ANY MEDICAL CONDITIONS OR RESTRICTIONS? THIS WOULD INCLUDE ALLERGIES AND MEDICATIONS TAKEN ON A DAILY BASIS.
By signing this waiver, I, intending to be legally bound, acknowledge the possibility of my child/ dependent/ myself being injured while attending the ENDLESS SUMMER SURF CAMP does exist. Surfing is a dangerous sport, and such hazards as hidden rocks, rip tides, sting rays, other marine life, and other dangers that come with the sport of surfing do exist. I/we fully recognize and understand the nature and existence of these inherent risks. In the event of any injury to my child/dependant/myself, (including my heirs and assigns), I hereby waive, hold harmless, and forever discharge from any liability damages or claims for damages for personal injury, including accidental death, as well as for claims of property damage against the ENDLESS SUMMER SURF CAMP,Progressive Surf Camps, Inc., Jason C. Senn, the camp's director and any officials, employees, or sponsors connected with this camp, and the US government, the State of California, and their members or agents. I also understand that any disruptive or damaging behavior on my part or on the part of my child will be due cause for dismissal from this camp, with no refund.
Signature: _________________________   Date

Parent/Guardian: _________________________   Date: