Indo Jax® Surf School Registration

2021 Charity Surf Camp Registration Form

Registration Information

Participant Name

Parent/Guardian Name

Height

Weight

Age

Street Address

City

State

Zipcode

Email Address

Phone Number

Special Instructions - Please add any additional information that might be beneficial for us to know such as mobility issues, etc.

Select Camp Dates

Wrightsville Beach, NC

Childhood Cancer Surf Camp In Memory of Donnalee Wilcox
August 3 - 5

Pismo Beach Area, CA

Special Needs Surf Camp West Coast *WAITINGLIST*
July 20-22
This camp is full. This is for the waiting list only.

By checking this box you indicate that you have read and agree to the Waiver ( Click Here to Read )
I Agree *

By checking below I indicate that I do NOT consent to the use of photographs or likeness of me taken by Indo Jax® Surf School for their own purposes.
No Photos, Please

*required