Parents of Summer Clinic Students:
Please Print a copy of this page, read and sign it, and then mail it to us with your deposit ONE WEEK IN ADVANCE to hold your space in the Summer Clinic.
L.B.I. Surfing Lessons L.L.C.
Mail all correspondence to:
Phone (609) 494-7873 ~ Email: firstname.lastname@example.org Internet: www.lbisurfing.com
All students, and guardians of participating students,
prior to enrollment and participation in L.B.I. Surfing Lessons L.L.C.,
(referred to herein and after in this document as L.B.I.S.L.) MUST first read, then complete the following Waiver of Liability and
I,___________________________________ agree to assume all risks incidental to participation in surfing and all
related activities associated with the L.B.I.S.L.. I hereby grant permission for myself or my child to attend the L.B.I.S.L. I hereby release L.B.I.S.L. from any and all liabilities, claims, actions, damages, costs, and/or expenses, arising from or in anyway connected with my participation in all surfing related activities conducted by L.B.I.S.L.
I hereby agree that L.B.I.S.L., its owners, officers, and instructors, are not in any capacity personally responsible or liable for any injuries or damage resulting from my participation in any L.B.I.S.L. programs. I fully understand and acknowledge that Surfing, Bodyboarding and Kayaking are inherently dangerous activities. I acknowledge and assume any and all risk associated with the presence of any and all Sea Life that may be in the ocean or on the beach.
Right To Photograph: By signing this agreement I hereby give my consent and approval to the L.B.I.S.L., that they shall have the rights, without obtaining my further approval, to photograph, take motion pictures of, televise, or reproduce in any manner or through any media, images of myself, my child, and my legal guardians. The L.B.I.S.L. shall have the right to, display, use, sell or license any such pictures or other reproductions for any purposes commercial or otherwise without monetary compensation to myself, my child or my Ward.
Yes ______ No _______ (Please Check One)
I hereby authorize any L.B.I.S.L. personnel to conduct any minor Medical First Aid that may be required for my child or myself.
Yes ______ No _______ (Please Check One )
I hereby authorize any Physician or Nurses selected by L.B.I.S.L. personnel to order and conduct medical or surgical procedures deemed necessary for myself or my child in an emergency situation. I understand that I will be responsible for all Hospital, Laboratory, and Doctor Fees.
Yes ______ No _______ ( Please Check One )
I verify that I am in good health and am fully capable of participating in any and all strenuous activities associated with any L.B.I.S.L. activities. I fully understand that each participant must be a competent swimmer and acknowledge that I am a competent swimmer.
Participant's signature Date
I, ________________________________________, as the parent or legal guardian of
__________________________________________, give permission
for my child or
(Guardian's Name) (Students name)
Ward to participate in L.B.I.S.L. activities. I do understand and acknowledge the above stated risks associated with my child or Ward's participation in surfing related activities with the L.B.I.S.L.
Parent or Legal Guardian Date
Summer Clinic Students only: This Release Form MUST be signed and returned with Deposit ONE WEEK before date attending to insure we will hold reservation. Failure to do so will result in loss of reservation!
*All deposits are refundable ONLY IF you contact us and cancel your reservation 7 days prior to your clinic date. After that deposits are nonrefundable, but can be applied toward private or group lessons