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Student Registration Form + Permission Slip

July 9th - 13th, 2018 // Daytona Beach, FL

Student Information
Name *
Name
Date of Birth *
Date of Birth
Phone *
Phone
Is Your Child A Good Swimmer? *
My Child Is Bringing Their Own Skim Board/Surfboard:
Please Note: 2XL (add $2.00) & 3XL (add $2.00)
Emergency Contact Information
Emergency Contact Name *
Emergency Contact Name
Emergency Contact Phone *
Emergency Contact Phone
Permissions & Acknowledgements
I Understand My $85.00 Deposit Is Due For This Trip Along With This Form By Wednesday, May 2, 2018. *
I Understand My Balance Is To Be Paid In Full By Wednesday, June 30, 2018. *
The total cost of the trip is $210. Your deposit of $85 is due May 2, 2018. You will then owe a remaining balance of $125 by June 30, 2108.
I Give Permission For My Child To Attend Adrenaline 2018. *
My child has a medical release form on file for 2018. There are always dangers involved with surfing and swimming in the ocean, so make sure your child understands the importance of listening to the chaperones and lifeguards.

If you would like to pay online, please click the button below. You may submit your deposit only or pay in full. Please designate your payment to "Youth Ministry."