Enrollment Form

Please Mail To:

143 Sandpiper Ridge Dr. Ormond Beach, FL 32176
Phone (386) 441-1110~Email: sales@daytonasurfingschool.com
Internet: www.daytonasurfingschool.com

 Click here for Downloadable Form  
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*All Deposits are refundable ONLY IF you contact us and cancel your reservation 7 days prior to your camp date.  After that deposits are not refundable but can be applied toward private or group lessons.

Student Information

First Name: ___________________________________________________

Last Name: ___________________________________________________

Age: __________    Male ______   Female _______   Date Attending: ______________

Parent or Guardians Information:

Name: _______________________________________________________

Relationship: __________________________________________________

Mailing Address: _______________________________________________ 

City: ____________________State: ___________________ Zip:________

e-mail address _________________________________(only used to send specialty camps)

Home Phone: ________________________________________
Day Phone: __________________________________________

Other Emergency Contact:

Name: _______________________________________________________ 

Relationship: _________________________________________________ 

Phone #: ______________________________________________________ 

Medical Information:

Allergies: _____________________________________________________ 

Medical Problems: _______________________________________________ 

Medications: ____________________________________________________ 

NOTES:  _______________________________________________________ 

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