INNER RHYTHM TEEN SURF CAMP REGISTRATION FORM

Applications need to be filled out in full and accompanied by a $500 deposit. Our camps fill up quickly so register early!

Applications can be submitted:
By phone: 250-726-3456 or 1-877-393-SURF
On-line Fill in this secure registration form.
Mail: Inner Rhythm Surf Camp, Box 421, Ucluelet B.C., V0R 3A0

Payments can be made using cash, Visa, M/C or certified cheque.

When the application has been processed, you will receive a telephone call confirming your booking and once deposit has been received we send out a confirmation letter, an information package, recipt and any other info requested at time of booking. .

If you do not receive this letter within two weeks of registration please call our office at 1-877-393 SURF

Contact Information

Payment Information

By entering this information I am authorising payments according to the following schedule:

A deposit of $500/camp upon booking. The balance must be paid in full 30 days before the start of the session date. Payment can be made by money order, cheque (insufficient funds $50 charge), Visa or MasterCard. Our cancellation policy is 30 days before the start of the session date ($20 administration fee will apply) anything less than 30 days is non-refundable.

List names of people authorized to pick up your children up

Swimming Ability: Poor Good Excellent

WETSUIT/SURFING INFORMATION:

Has your child ever surfed before? yes no (if yes, how long?)

What specific things does the camper hope to accomplish at surfcamp this year?

CONFIDENTIAL HEALTH HISTORY

CAMPER MEDICAL INFORMATION:

ALLERGIES:

Allergic to, please rate mild, moderate or severe allergy

MEDICATION:

Is the camper under any form of treatment/medication for an illness, condition, injury? yes no If yes please explain:

Has your child had a medication for ADD/ADHD during the past year? yes no

List all medications your child is bringing to camp and the specific directions for their use, please include dose and interbal. (Please attach a separate sheet if needed)

Does your child have difficulties which may require some program adaptations? yes no

(learning disability or physical disability)

Comments

CAMPER’S COMMITMENT:I want to be a camper at Inner Rhythm Surf Camp. I agree to abide by camp rules. I will do my best to make this a good experience for myself and fellow campers. I understand that failure to do this promise might result in dismissal from camp.
The camper has read, understood and agrees to their commitment

PARENT’S COMMITMENT: I have discussed the Camper’s and Parent’s Commitment with my child and confirm that this camper agrees to participate in full in the program, to follow safety instructions and or refrain from behaviour that is harmful to oneself or to others. I understand and support the camp policy that prohibits the use of tobacco, alcohol or non-prescriptive drugs and understand their use as well as abusive behaviour is cause for dismissal from camp without refund of camp fees.

AUTHORIZATION: In permitting my child to attend Inner Rhythm Surf Camp, I the undersigned permit my child to participate in the full range of camp activities and authorize the Camp director or his/her appointee, in the event of accident or illness affecting this above named camper to authorize on my behalf all procedures, including admission to hospital and necessary treatment therein, as he/she may deem essential for the care and well being of the camper. Such action is only to be taken when immediate contact with the undersigned cannot be made. It is understood that Inner Rhythm is not responsible for Medical Care Cost. I authorize Inner Rhythm Surf Camp to use any photos of my child obtained while engaging in Inner Rhythm Surf Camp’s program.

The parent has read, understood and agrees to their commitment and authorises the child to participate

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Refund Policy

Cancellations must be submitted in writing, including the camper's name, and the session registered for. Cancellation notifications made more than 4 weeks before camp starts receive full refunds minus a $20.00 administration fee.

Cancellation notifications made less than 4 weeks prior to camp will lose their deposit. Should a child be required to leave a session for medical or behavioural reasons, there will be no refund of fees. In the event of a medical emergency preventing the camper from attending camp, a full refund except a $15 administration fee will be issued upon receipt of a physician's certificate.

Submit Cancellations to Inner Rhythm Surf Camp, Box 421, Ucluelet B.C, V0R 3A0.

The camper has read and agrees to the conditions of the participants waiver (see below)