Surfer Name*

Gender*
 Female Male
Birthday* (dd/mm/yyyy)

Camper Phone
(a cell # is helpful when campers are traveling to us, but not necessary)

Surfer Email

Available Sessions
---Week 1: June 13-18Week 2: June 20-25Week 3: June 27-July 2Week 4: July 5-10Week 5: July 11-16Week 6: July 18-23Week 7: July 25-30Week 8: July Aug 1-6
To sign up for two consecutive weeks, just click on the first week you want then hold "Shift" and click on the second week.
Got a board?
 Yes No
I'm bringing a:
 Longboard Shortboard Soft-top Bodyboard Skimboard
Skill Level
---BeginnerIntermediateAdvanced
Shirt Size*
---SmallMediumLargeExtra Large
Is the surfer uncomfortable with or allergic to dogs? (If YES, please explain below. We have a very friendly Golden Retriever)  yes no
Medical Problems, Allergies, Medications*
None
Insurance Carrier*

Policy Number*

Contact Name*

Email*

Phone*

Alternate Phone

Address

Address (continued)

City/town*

State*

Zip Code*

Emergency Contact *

Emergency Contact Phone *

Alternate Emergency Contact

Alternate Emergency Contact Phone

A $400 down payment plus $25.50 tax will hold your child's spot.

Payment Method
 Check/Money Order Credit Card/Paypal

I have read and understand the Surf Hatteras Cancellation Policy and Zero Tolerance Policy. (Found at the bottom of this page.)*

I have read and understand the Surf Hatteras Liability Release

I have read and agree to the terms of Surf Hatteras Photo & Video Release.

How did you hear about us?
---GoogleGoogle Advertisement (in blue)Yahoo!MSN SearchAOL SearchOther Search Engine (say below)Surfline.comwww.swellinfo.comKidsCamps.comFacebook AdOur Link on Another Website (say below)Attended last summerFriend/Family Referral (we'd love to know who)Brochure in MailBrochure on DisplaySurfer MagazineThe Virginian PilotConnections Summer Camp GuideTidewater Parent MagazineSteel Pier Longboard ClassicOther (say below)
Message/Comment/Question
None

Once your form has been submitted successfully, instructions will appear below regarding how to pay your deposit.

This form may take several moments to process. Please click "Send" only once, and a message will appear when your registration is successful.