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Mail all correspondence to:
143
Sandpiper Ridge Dr. Ormond Beach, FL 32176
Phone
(386) 441-1110~Email: sales@daytonasurfingschool.com
Internet:
www.daytonasurfingschool.com
All students, and guardians of participating
students, Prior to enrollment and participation in the Daytona Beach
Surfing School,(referred to herein and after in this document as D.B.S.S.)
MUST first read, and then complete the following Waiver of Liability and
Acknowledgement Form.
I,________________________ agree to assume all risk incidental to
participation in surfing related activities (Student name)associated
with the D.B.S.S. I hereby grant permission for myself or my child to
attend the D.B.S.S. I hereby release D.B.S.S. from any and all
liabilities, claims, actions, damages, cost, and/or expenses, arising
from or in anyway connected with my participation in all surfing related
activities conducted by D.B.S.S.
I hereby agree that
D.B.S.S. and 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 D.B.S.S. programs. I fully
understand and acknowledge that Surfing, Body boarding 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 D.B.S.S. , 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 D.B.S.S. 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 legal guardian.
YES ______
NO______ (Please initial one)
I hereby authorize
any D.B.S.S. personnel to conduct any minor Medical First Aid that my be
required for my child or myself.
YES ______
NO______ (Please initial one)
I hereby authorize
any Physician or Nurses selected by D.B.S.S., personnel to order and
conduct medical or surgical procedures deemed necessary form 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 initial one)
I verify that I am
in good health and am fully capable of participating in any and all
strenuous activities associated with any D.B.S.S. 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,
_________________________________(Parent / Guardian
name) , as the parent or legal guardian of
_______________________________(Student’s Name) give my permission for
my child or ward to participate in D.B.S.S., activities. I do
understand and acknowledge the above stated risks associated with my
child or Ward’s participation in surfing related activities with the
D.B.S.S.
Parent or
Guardian: ____________________________________________________
Date: ____________________
Summer
Camp Students only: This Release Form MUST be signed and returned with
Deposit ONE MONTH 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 camp date.
After that, Deposits are not refundable, but can be applied toward
private or group lessons.
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