Secondary School Package – Register Here Student Name* First Last School*Form ClassDate of Birth* Are you Male or Female ?*MFAddress* Street Address Address Line 2 City ZIP / Postal Code PhoneMobile*Email* How many lessons have you had before?Please list any medical conditions our instrcutors need to be aware ofe.g Asthma, Allergies, InjuriesSwimming Ability*Please let us know your swimming ability. You can still participate if you can't swim 50 m but we need to be aware of that.I CAN swim 50mI CANNOT swim 50mEmergency Contact Person*Emergency Phone*Preferred Class*Lessons start the week beginning 20th FebMon 5.15 pmTues 4.30pm Sumner (Full T1 2017)Thurs 4.30pm SumnerFri 4.30pm SumnerFri 4.30pm New BrightonSat 3.30pmSun 3.30pmOtherLessons*Four lessons - $108Six lessons - $158OtherTerms & ConditionsThe course will consist of four / six 2 hour lessons at the agreed time. Professional Surf Coaching Ltd reserves the right to postpone or cancel lessons due to unforeseen circumstances or adverse weather.The cost is $108 / $158 paid in advance for all four / six lessons. No refunds. If, due to illness or injury, a student is unable to attend four / six lessons. Professional Surf Coaching Ltd will arrange for supplementary lessons or equivalent only on presentation of a Medical Certificate. 24 hours notice required. N.B. $5 admin fee per change.The participant accepts that the sports of surfing and bodyboarding contain an element of risk. The participant accepts that in the event of injury or death Professional Surf Coaching Ltd and its instructors will not be held liable. The participant agrees to follow all directions given by the instructors. Professional Surf Coaching Ltd accepts no responsibility for theft or damage to property belonging to the participant.I agree to these terms and have permission from my parents to attend.* YesNewsletterWe need your email to confirm your registration but we also send out an occasion newsletter with extra hints and tips, specials offers and updates. Yes. Add me to your mailing listPayment*Must be received before the start of your first lesson. Cheques to Professional Surf Coaching Ltd. Bank acc 03 1599 0101039 00. Upon submitting you'll be directed to payment options.cash / chequeinternet bankingcredit card via pay palgift voucherschool account ( please check your school allows this option)Comments This iframe contains the logic required to handle Ajax powered Gravity Forms.