3-DAY AFTERNOON SURF CAMP GIFT CERTIFICATE

Name(s)

Age(s)

Emergency Contact (Name and Phone Number)

List any Medical Conditions or Special Needs

I have read and agree to the WRV Release and Waiver of Liability:

The purchaser of this lesson hereby acknowledges that participation in the lesson(s) and related activities involve inherent risk of physical injury, and that the purchaser, on behalf of the registrant, hereby assumes all such risk and does hereby release and forever discharge WRV and all employees and agents thereof from any and all known liability of whatever kind of nature, arising from and by reason of any and all known and unknown, foreseen and unforeseen body and personal injuries, damage to property, and the consequences thereof, resulting from the registrant's participation in or involvement with this lesson, including any failure of equipment or defect in the premises. I hereby state that I am the legal guardian of said child.