Learn to Surf - Register Here - Learn to Surf

Name*

First Last

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Are you Male or Female ?*

Male
Female

Date of Birth*

Address*

Street Address Address Line 2 City ZIP / Postal Code Country

Phone*

Mobile*

Email*

Newsletter

We need your email to confirm your registration but we also send out an occasional newsletter with extra hints and tips, specials offers and updates.

Yes. Add me to your mailing list

Emergency Contact Person*

Emergency Phone*

Please list any medical conditions our instrcutors need to be aware of

e.g. asthma, allergies, injuries.

Swimming 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 50m
I CANNOT swim 50m
I CAN swim 200m

How did you hear about us?*

Lesson Time

If you've made a booking already put your class date and time here.

Package*

Payment*

Professional Surf Coaching Ltd. Bank acc 03 1599 0101039 00. Upon submitting you'll be directed to payment options.

cash / eftpos
internet banking
credit card via pay pal
gift voucher (please enter voucher number in comments below)

Disclaimer

The participant accepts that the sport 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

View our Terms & Conditions →

Do you accept the above disclaimer and agree to our Terms and Conditions?*

Yes

Comments

Learn to Surf – Register Here

Learn to Surf - Registration Form NEW

Disclaimer