Corky Carroll's Surf School

Registration Form 2010
Huntington Beach

TO EXPEDITE YOUR REGISTRATION SEND TO THE FOLLOWING MAIL ADDRESS

19051 GOLDENWEST ST. STE 106 #148, HUNTINGTON BEACH, CA 92648

 

THE FOLLOWING FORM IS FOR THE WEEKLY SURF CAMP ONLY

 

Instructions : Please hit your refresh button we are always changing the website to make registration easier.

  1. Simply fill out the form, print and send to the surf school address. (19051 Goldenwest St. STE 106 # 148Huntington Beach, CA 92648). This address will expedite your registration
    Faxes will not be accepted.
  2. Sign the disclaimer.
  3. If paying by credit card fill out the credit card information and sign. (Mastercard, Visa, American Express )
  4. A 50% deposit or full payment must be received with the registration. Balance is due first day of school.
  5. If you are registering for more than one week and want the discount you MUST PAY for the weeks in advance.
  6. Make sure you receive a confirmation letter so you can drop off and pick up.

      7.  

    1. Complete Basic Information
    Participant's Name
    Birth date
    Friend/Relative
    Parent/Guardian
    Address
    City
    State
    Zip
    Telephone
    Parent/Guardian Work#
    Insurance Carrier
    Policy Number
    Physician
    Telephone
    Dentist
    Telephone
    Preexisting Medical Condition

    2. Select Your Session

    PLEASE CIRCLE  WHICH SESSION FOR HALF DAY

    Summer Surf Camp Full Day/Weekly/$270

    		   PLEASE CIRCLE FULL DAY WEEKLY
     

    Summer Surf Camp Half Day/Weekly/$145 

    Please circle time 8am-11am or 12pm to 3pm

    		PLEASE CIRCLE HALF DAY WEEKLY AND 8 TO 11 OR 12 TO 3   
    DO NOT FORGET TO CIRCLE TIME FOR HALF DAY

    3 . Select Your Week 2010

    DO NOT FORGET TO CIRCLE YOUR WEEK OF CHOICE

    Week 1 - 6/7 - 6/11 Week 2 - 6/14 - 6/18
    Week 3 - 6/21 - 6/25 Week 4 - 6/28- 7/2

    Week 5 - 7/5 - 7/9

    		Week 6 - 7/12 - 7/16

    Week 7 - 7/19 - 7/23

    		 Week 8 - 7/26 - 7/30

    Week 9 - 8/2 - 8/6

    		 Week 10 - 8/9 - 8/13
    Week 11 - 8/16 - 8/20 Week 12 - 8/23 - 8/27
     

     

    4. Payment Information
    Enter the Amount Due (in US$)
    Please send check or if you pay by credit card use the form below.  We must receive a 50% deposit or full payment  with this registration.  Without payment registration is not accepted.   "NO REFUNDS"  

    5. Disclaimer
    This release limits your rights to recover any damages in case of accident. This must be signed.  In consideration of your acceptance of my application form, I, intending to be legally bound, hereby for myself, my heirs, executors and administrators, hold harmless and release Corky Carroll's Surf School, U.S. Government, the City and County governments concerned, the State of California, their members or agents, any officials or employees connected with this school and any sponsor of Corky Carroll's Surf School from any responsibility or liability or any injury or property damage arising from my or my child's participation in Corky Carroll's Surf School.  In addition, I certify that I or my child is qualified to swim in the ocean and understand that any violation of rules set forth by "Rules of the Beach" on my part or on the part of my child will be due cause for me or my child's immediate dismissal from this school with NO REFUND.  I  understand that any deposit and/or tuition is "NOT REFUNDABLE" for ANY reason.  I also understand that being late for scheduled class or orientation may result in waiting for the next scheduled class or orientation.  I acknowledge that by signing below I have read  agree and understand all of the above especially there are NO REFUNDS.  Make sure you have circled your time for half day. I acknowledge that pictures of my child may be taken and used for the Corky Carroll Surf School website.

     


    Participant Name __________________________

    Parent/Guardian Signature _________________________________
     

    IMPORTANT...CREDIT CARD USERS

    I,___________________authorize Corky Carroll's Surfschool to charge (amount)_$_______________ to my credit card.

    Credit Card Type_________Account#_____________________Exp. Date__________

    Signature_____________________Date___________

    Billing Address________________City/State/Zip________________Phone_________

    MAKE SURE YOU HAVE CIRCLED YOUR TIME FOR HALF DAY

    We accept Mastercard, Visa, American Express

    PLEASE PRINT AND SEND VIA U.S. MAIL

    FAXES ARE NOT ACCEPTED