FIRST NAME
PRIMARY CONTACT NUMBER
EMAIL
LAST NAME
GENDER
CITY
STATE
MEDICAL CONDITIONS
Please let us know of any conditions you may have that would require any special assistance. If none please write NA.
PERSONAL INFORMATION
LESSON INFORMATION
$120 per person/2 hour session for private lessons
$100 per person/2 hour session for multiple lessons or 2+ students
NUMBER OF LESSONS
TYPE OF LESSON
WETSUIT INFORMATION
DATE OF LESSON
TIME OF LESSON
EMERGENCY CONTACT NUMBER
FRIENDS OF SCSS
​Include the height and weight for each participant.
ADD ONs
HOW DID YOU HEAR ABOUT US?
HEIGHT
WEIGHT
Surf Lesson Sign Up Form
Please provide the following information
