Full name

Age

Email Address:

Telephone

Level of Surfing Ability

Can you swim 50m in deep water? Yes No

Can you tread water for 2 minutes? Yes No

Course Date

Course Time

Do you have any medical details we should be aware of? Any illness or allergy? Yes No

If 'yes', please specify, including medication:

Any further comments? Feel free.

Release & Indemnity

My participation in the program is entirely at my own risk and I agree to;

(a)   release and forever discharge the Surf School from all liability and claims that I my have or have had but for this release arising from or in connection with my participation in the Program;

 (b)   indemnify and hold harmless the Surf School to the extent permitted by law in respect of any claim by any person including but not only another participant in the Program arising as a result of or in connection with my participation in the Program.

 In this clause 6 “Claims” means and includes any action, suit, proceeding, claim demand, damage, penalty, cost or expense however arising ( including negligence, trespass to the person or for breach of implied terms in the sale of services under the section 74 of the Trade Practices Act  ( 1974) Cth and equivalent provisions contained in State sale of goods or fair trading legislation).