(*WINTER 18*) NUGGET SURF LESSONS / PRACTICE CLUB MEMBERSHIP Participant Agreement and Waiver of Liability First Name: Last Name: Birthdate / / Gender: Age: Grade: Name of School: Address: City: State: Zip: E-mail: Contact Parent/Guardian: Phone #: 2nd Parent/Guardian Name: Phone #: Emergency Contact Name Emergency Contact Telephone PARTICIPANT HEALTH INSURANCE INFORMATION Health Insurance Provider Policy Id/Number Subscriber information List Medication, medical issues, allergies or special dietary needs: CHECK YOUR SELECTION: Swimming Ability: Times in waves: Surfing Ability: Novice Average Expert 1-10 10-20 20-30 more the 30 Never Surfed Beginner Intermediate Advanced LESSONS: SEMI-PRIVATE LESSON Students will be paired up with another rider with similar experience. Goals, corrections, and tips tailored specifically to each Surfer will be provided during these sessions. Lessons are approximately 2 hours long. NUGGET SEMI-PRIVATE LESSON -$75 per person per lesson PRIVATE LESSIONS - Progression on essential surf skills such as paddling, duck diving, pop-ups, positioning, and timing will be provided during these sessions. Lessons are approximately 2 hours long. NUGGET PRIVATE LESSON -$125 per lesson
SURF PRACTICE CLUB: (2018 Winter Program 01/02/18 03/30/18) Our supervised practice sessions are held daily at Local Beaches around Orange, and San Diego Counties. We will pick up your Nuggets at predetermined drop off locations in Laguna, Beach, Dana Point or San Clemente and take them to a Surf Break tailored to their ability. Surfers will be evaluated monthly to determine their Progression, Goals, Corrections, and Attitude. NUGGET SURF PRACTICE CLUB MEMBERSHIP FEE - $75.00 Membership Rates; Monthly: STANDARD MEMBERSHIP PRIVATE LESSON PACKAGES: (1 sessions per week) - $249 per month (4 Sessions/Month) 3 LESSONS - $350 8 LESSONS - $750 5 LESSONS - $550 10 LESSONS - $900 PAYMENT AUTHORIZATION I agree to pay the $75.00 Nugget Surf Practice Club Membership Fee along with the first month s membership today the amount of $ Name on Card Credit Card Number Type Exp. Date Security code MC/Visa Signature of Cardholder I agree to pay the Monthly Nugget Surf Practice Club Membership Fees of $ in advance on a recurring basis beginning the month of. I authorize Nugget Surf, without further notice, to charge my credit card above for the monthly Membership between the first and fifth of each month in advance. I am an account holder and I have actual authority to use the credit card with which my Membership Fee payments will be made. In order to cancel or withdraw authorization for this recurring Monthly Membership Fee payment, I agree to follow the Cancellation Policy below. CANCELLATION POLICY Cancellation within 3 Days or Before First Service. I may obtain a refund of any amount I have paid under this Agreement if I cancel it within three (3) business days of my registration date or before the lesson / practice session, whichever is later. Cancellation after Practice Session. Once the first lesson / practice session (after the 3-day window to cancel) has occurred, I may cancel this Agreement at any time, but all payments I have made to or that have been processed by Nugget Surf prior to its receipt of my written cancellation notice are nonrefundable. To cancel this Agreement, I will deliver a written cancellation request to a Nugget Surf employee or representative. I agree that I must pay for all lessons scheduled within the 30 days after Nugget Surf s receipt of my request to cancel. WAIVER RELEASE OF LIABILITY WAIVER AND ASSUMPTION OF RISKS AGREEMENT **Caution** do not sign this document without reading it in its entirety. By signing this you give up important legal rights. Surfing is an athletic activity the participation of which involves certain risks. Please read and understand this document.
This is a legal document, my signature is my acknowledgement of the contents of this contract. I will not sign this unless I fully understand and agree to be bound by its contents. 1 I know how to swim and maintain buoyancy in the open water and I am in good health: My swimming skills are above those of a novice and I can keep my head above water without my feet touching the bottom for extended periods of time. Likewise I am in good physical and mental health. I am not under the influence of drugs or alcohol or other substances which may impair my swimming skills or ability to take and follow instruction. I am not pregnant and do not suffer from any spinal or skeletal defect hearing, vision or balance impairment or any other physical impairment. I understand that forgoing representations as to my physical condition are being relied upon by Nugget Surf. I hereby agree to follow all rules, regulations, and instructions of Nugget Surf while participating in a class, lesson, practice session, or by renting the equipment from Nugget Surf. 2 I acknowledge that surfing may be a dangerous sport and assume such risks: I am aware open water activities in general can be dangerous and surfing specifically involves inherent risk. I may damage my belongings, get hurt, get injured, become ill, drown, or even die. I further acknowledge that I have voluntarily chosen to rent equipment, take surf lessons, or participate in practice sessions from Nugget Surf, or if the individual taking said lessons is a minor I have as the Parent or legal guardians voluntarily consented to such minor taking such lessons or renting equipment. I know and fully understand that surfing is a dangerous outdoor activity in an uncontrolled environment with inherent risks and hazards where serious accidents can occur participants can sustain property damage, injury, illness, or even die. I acknowledge and willingly and voluntarily assume all risks and hazards in surfing or beach related activities in all phases of these activities from the training sessions till the conclusion of class, lessons or equipment rental period including but not limited to loss of board control, collisions, falls from surfboard, malfunction of equipment, collision with any man made or natural object, submersion in water, encounters with animals, marine life, algae bacteria, extreme temperatures sun damage including travel by foot vehicle or any other method related to this activity, unavailability of appropriate medical attention. I understand and acknowledge the above list is not meant to be complete or exhaustive and that the other unforeseen or unanticipated risks known or unknown may also exist and result in injury, illness, disease or death 3. I hereby waive my right to sue Nugget Surf: In consideration for Nugget Surf agreeing to provide me with surf instruction, practice sessions, equipment rental or and or allowing me to participate in this class or lesson, I agree that I shall not make claim or bring action against, sue, or hold responsible Nugget Surf it s Owners (including Erik Stiers,) officers, agents, employees, associates, and representatives, (referred collectively in this agreement as (Nugget Surf) or expect require or pursue them, to be held accountable for any damages. I voluntarily agree to release, discharge, and hold harmless Nugget Surf and from and against any and all claims of liability even those arising out of their negligence, fault, recklessness, or any other act of act of omission which causes me damages and discharges Nugget Surf from any act of omission, excluding acts of gross negligence, in rendering or failing to render any type of rescue, emergency or medical services. 4. Indemnity: I further agree, to hold harmless, defend and indemnify Nugget Surf from all defense costs, including attorney s fees incurred in connection with any claim arising from the activities herein, including but not limited to those for bodily injury, wrongful death, or property damage whether caused or sustained by any minor under the age of 18 on whose behalf I m signing, or which I may have cause to spectators or other third parties whether negligent or not in the course of my participation in this activity. In the event, of any actions regardless of where venue lies, any such actions shall be filed in the state court of Orange County California. In the event that any action is filed other than in the state court of Orange County, California it shall be moved to the state court of Orange county, California on a motion and at the option of Nugget Surf.
5. Transportation Release: I hereby give permission to authorized representatives of Nugget Surf and its contracted drivers to provide transportation in an authorized vehicle for myself or my child to be transported to and from lessons or practice sessions. I do herby indemnify and hold harmless Nugget Surf and it s administrators, employees, and persons transporting myself or my child for any claim arising out of injury or accident or incident in the course of providing transportation for myself or my child. 6. Permission to obtain medical assistance: In the event of injury, illness, or emergency, accident, or other harm sustained by me (or by the minor on whose behalf I m signing this document), I hereby give permission to obtain medical assistance, in which event I hereby make the same releases and waivers in Nugget Surf favor as I have otherwise made in this agreement in connection with any such medical assistance sought or not sought in addition the expenses for any such medical emergency shall be my sole responsibility and not that of Nugget Surf. 7. Promotional use of images: I hereby agree Nugget Surf may use film or photographic records of my participation in surfing classes, practice sessions, coaching sessions, and other activities I may participate in with Nugget Surf for its promotional use without compensating me, and I consent to the use of my name and likeness for such a use in any media known or not known. I HAVE READ THIS DOCUMENT IN ITS ENTIRETY AND IT IS MY INTENTION THAT IT BE BROADLY CONSTRUED IN THE FAVOR OF NUGGET SURF IN THE EVENT OF ANY AMBIGUITIES, WHICH SHALL BE RESOLVED IN NUGGET SURF S FAVOR. I UNDERSTAND THAT I OR ON BEHALF OF MY MINOR CHILD AM ASSUMING ALL RISKS INHERENT WITH THIS SURFING ACTIVITY, AND THAT I OR MY MINOR CHILD MY BE INJURED OR BECOME ILL OR EVEN DIE AS A RESULT OF SURFING. I UNDERSTAND THAT THIS IS A RELEASE OF ANY AND ALL CLAIMS. I UNDERSTAND THAT THIS ENTIRE AGREEMENT BETWEEN ME AND NUGGET SURF AND THAT NO REPRESENTATIONS HAVE BEEN MADE TO ME BY NUGGET SURF OUTSIDE THIS AGREEMENT. I VOLUNTARILY SIGN MY NAME AS EVIDENCE OF MY ACCEPTANCE OF ALL THE PROVISIONS IN THIS RELEASES AND MY AGREEMENT TO BE BOUND BY THEM. POLICIES (SUBJECT TO CHANGE) 1. Class fees are non-refundable, except in the following circumstances: a. For medical disabilities, a prorated refund or credit will be given when participant provides a doctor s note stating they cannot participate in the program. b. If a class, practice session, or coaching session is canceled, every effort will be made to find a suitable class for the participant who has registered for the canceled class. If a suitable class cannot be found, the participant will be provided a full refund. If a refund is granted, the refund will be issued in the form of a credit on the membership account. 2. Make-up classes are not given for any class, practice session, or coaching session missed by participants. I have read this Agreement thoroughly, understand all of its terms, received a copy, and have knowingly and voluntarily signed it. IF PARTICIPANT IS UNDER 18 YEARS OF AGE: I, the undersigned parent or legal guardian of the participant, hereby execute the foregoing for and on behalf of the participant. Participant Signature: Participant Name: Date: Guardian Signature:
Guardian Name: Date: