Summer of Surf
Expressions of Interest and Registration
Email address *
Child #4 Name:
Your answer
Medical Conditions of Note - Please state the child’s name, the medical condition and specific treatment required.
Your answer
I have some questions (please complete below)
Your answer
Your child(ren) will need the following each day:
If not registering for full weeks, please complete.... I would like to register my child(ren) for the following days. Please clearly list dates you would like.
Your answer
Please register my child(ren) for the following dates
Child #1 Age:
Your answer
Member of Waihi Beach Lifeguard Services, Junior Surf *
Child #4 Age:
Your answer
Your name *
Your answer
Child #2 Age:
Your answer
Child #1 Name:
Your answer
Contact Mobile Number: *
Your answer
Emergency Contact - Name & Mobile Phone *
Your answer
Child #3 Name:
Your answer
I give permission for my child(ren) to be transported in a Club or private vehicle if required due to weather conditions at main beach to take the group to Anzac Bay. All vehicle drivers have a full, clean driver's licence. This may not be necessary unless excessive wind or surf conditions make it safer to operate at Anzac Bay. *
Child #3 Age:
Your answer
Please register my child(ren), details below:
Your answer
Child #2 Name:
Your answer
PAYMENT
We will invoice you for sessions, but request that you make payment in advance. Eftpos/Credit Card payment available if required at the Club when signing in children.
I understand that full payment is required in advance. Weekly payments may be made prior to the start of each week’s sessions. *
Online payments to:
03-1576-0021159-000
A copy of your responses will be emailed to the address you provided.
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