This registration page is for one (1) camper. If you need to register additional campers to your group, please refresh/reload the Surf & Yoga Retreats Registration page AFTER clicking the “Submit Registration” button and receiving your confirmation. Then fill out the information forms for each additional camper. We also require a $200 deposit to reserve your spot. To pay with a credit card call our office at 831-423-0928 or to by check, send to Richard Schmidt Surf School, 849 Almar Ave. Box 192 Santa Cruz, CA 95060 Thank you!!

Note: If you came here looking to book our Santa Cruz Surf Camp, we are currently not offering our summer surf camps at this time. We invite you to spend a week with us exploring and surfing Costa Rica instead!

Surf & Yoga Retreat Registration Form

Which surf camp or retreat are you registering for? * Costa Rica Surf & Yoga Retreat

Which week? * Costa Rica – Week 1: JAN 9-FEB 5, 2022Costa Rica – Week 2: FEB 5-12, 2022

Camper's Name *

(First and last name)

Age *

Gender *

Male

Female

X

Address 1 *

Address 2

City *

State/Province/Region *

Zip/Postal Code *

Country *

E-mail Address *

Phone Number *

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Surfing Experience * First-TimerBeginnerIntermediateAdvanced

Where did you hear about us? Website / Internet SearchBrochureSocial MediaSurf Shop/RetailerHotelFriend/FamilyTaken an RSSS lesson or surf camp beforeHappened to see the Surf School at the beachAd (radio, TV, newspaper, magazine)Other

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Indicate any food restrictions, allergies, or medical conditions we should be aware of:

Do you have medical insurance? *

Yes

No

If YES, name of insurance company

Person to contact in case of emergency *

(First and last name)

Phone Number *

E-mail Address *

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MEDICAL PERMISSION - (If the participant is under 18 years of age) In case of emergency and parent or guardian cannot be reached, call the family doctor or physician. *

Yes, I give my consent

Doctor/Physician's Name *

Phone Number *

This is to certify that if the person below should become ill or have an accident requiring emergency medical care, and if the parent or guardian cannot be contacted, the Camp Director has permission to authorize such actions as he/she deems necessary. *

Enter Camper's Name

PARENT'S DECLARATION: To the best of my knowledge, this camper has not been exposed to any contagious or infectious disease during the past three weeks. I give permission for this camper to engage in all camp activities. (List any exceptions below.) *

(Signature of Parent or Guardian) – Enter name of parent or guardian if under age 18

List exceptions here:

Signature of Camper

(Enter name of camper)

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