Lou Maresca & Lisa Mead's
CENTRAL FLORIDA SURF SCHOOL
www.surfschoolcamp.com
 

Office: 321-733-6422

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*Please use your the PRINT button / feature within your browser to print this form, and then complete*

Registration and Hold Harmless Form

Your Name:
Birthdate:	Age:
Address:
Parent/Guardian:
City/State/Zip:
Home Phone:	Work Phone:
Emergency Contact name:		Phone:
Persons Authorized to Pickup Minor:

Have you, or your minor student, been in the hospital during the past 12 months for treatment?
Recovered fully?
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