Week Session & Surfsup Seals Applictions

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Step 1 of 3

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Parent / Guardian*

First Last

Email*

Cell Number*

We will use this number for whatsapp communications mainly

Child (Children) Details*

Child 1 Name

Age

Birthday

Please use the plus icon to add more children

Medical Details

Medical Details Checklist

I do not have a medical aid

I do not have a house doctor

I/we do not have any medical conditions

I/we are not on any medication

I/we do not have any allergies

Medical Aid

Main Menu

House Doctor

First Last

Please list all medical conditions

Please list the participant(s) with the medical conditions. Each name on a separate line.

Please list all medications

Please list the participant(s) with the associated medication next to each name. Each name on a separate line.

Please list all allergies

Please list the participant(s) with the associated allergy next to each name. Each name on a separate line.

Emergency Details

Emergency contact

First

Contact Number

Legal Matters

Social media and website exposure*

Yes, It is ok with me

NO, please do not

From time to time we take photos of our participants. May we post photos or video content of you on our social media platforms

Consent*

I agree to the terms and indemnity conditions

Please note that this indemnity is valid for 1 year from date of signing this form. Children under 18 must have a parent or guardians signature.

I accept the Surf’s Up Mossel Bay (Pty)Ltd, it’s owners, coaches and assistants will take all possible care, but will not be held responsible or liable for any injury or damage, which I/my child may sustain to property or person, during this and further surfing lessons and events I/my child may undertake with the school – irrespective of whether or not such injuries or damages arose as a result of negligence, injury, theft or from any cause whatsoever. I understand the accidents in surfing, such as collision with other surfers or with own board, collision with ocean floor or rocks, contact with ocean creatures as well as other incidents, are possible. I/my child enter into this lesson or event at my/his/her own risk with my consent. I further agree to adhere and abide to the rules and regulations of the surf school. I agree that any photographs, video footage taken during lessons remains the property of the surf school and may be used for marketing purposes. I agree that if the need arises the surf school can take the necessary emergency medical action and I will be responsible for payment of any charges which arise from these actions.

By ticking this box, I agree to abide by the rules and regulations laid out by Surf’s Up Mossel Bay (Pty)Ltd.

Signature (sign with your finger/mouse)*

Spam security question*

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