COASTLINE ADVENTURES SURFING SCHOOL REGISTRATION FORM
Name: ____________________________________________________________________________
Address: __________________________________________________________________________
City: __________________________________ State: _____________ Zip: ____________________
Day Phone #: ___________________________ Evening Phone #: ___________________________
E-mail: ___________________________ Birth Date: ____________ Age on Day of Camp: ________
Parent/Guardian’s Name: _____________________________________________________________
Emergency Contact: _________________________________________________________________
Emergency Telephone #: _____________________________________________________________
Allergies or Medical Information of Importance: ___________________________________________
__________________________________________________________________________________
How Did You Hear About Us? Newspaper __________ Surf Shop __________ Web Site __________
Magazine Ad__________ Friend __________ Self __________ Other ____________________________
Coastline Adventures
P.O. Box 1274, Normandy Beach, NJ 08739
732-300-5115 njsurfschool.com
For office use only: Surfboard size: _____________ Wetsuit size: _____________
Method of payment: cash $_____________ check #/amount ____________ on-line _____________
Service: __________________________ Notes:
COASTLINE ADVENTURES SURFING SCHOOL

ASSUMPTION AND ACKNOWLEDGEMENT OF RISKS
RELEASE OF LIABILITY AND INDEMNITY AGREEMENT
In consideration of being allowed to participate in water sport events and activities and/or being provided with water sport recreational property or services, for myself and any minor children whom I am parent, legal guardian or otherwise responsible, and for my/our heirs, personal representatives or assigns:
1) ACKNOWLEDGEMENT OF RISKS. I acknowledge that WATER SPORTS AND WATER RECREATIONAL ACTIVITIES ARE VERY
DANGEROUS and involve SERIOUS INJURY AND/OR DEATH. Risks include but are not limited to changing tides and water flow, collisions, inclement weather, lightning strikes, sea creatures and sea pests, equipment failure, operator error, all of which can serious injury, paralysis and/or death. (Initial Here __________)
2) EXPRESS ASSUMPTION OF RISK AND RESPONSIBILITY. I agree to assume responsibility for all the risks of the activity, whether above or not, EVEN THOSE RISKS ARISING OUT OF NEGLIGENCE OF THE RELEASEES NAMED BELOW, My/our participation in the activity is purely voluntary. I assume full responsibility for myself and any minor children for whom I am responsible, for any bodily injury, accident, illness, paralysis, death or loss of personal property even if caused, in whole or in part, by the negligence of the releasees named below, to the fullest extent permitted by law. (Initial Here __________)
3) RELEASE. I hereby release COASTLINE ADVENTURES, its principal, directors, officers, agents, employees and volunteers, and each and every landowner, municipal and/or governmental agency upon whose property an activity is conducted (“owner”), if any,
(Collectively “releases”) FROM ANY AND ALL LIABILITY OF ANY NATURE FOR ANY AND ALL INJURY OR DAMAGE (INCLUDING DEATH)
TO ME OR MY MINOR CHILDREN OR ANY OTHER PERSONS as a result of my/our participation in the activity, EVEN IF CAUSED BY THE
NEGLIGENCE OF ANY OF THE RELEASEES NAMED ABOVE OR ANY OTHER PERSON (INCLUDING MYSELF) to the fullest extent permitted by law.
This release is intended to be as broad and inclusive as permitted by law, and if any portion thereof is held invalid, the balance shall continue in full legal force and effect. This release shall be binding on my heirs, executors, administrators and assigns.
(Initial Here __________)
4) RELEASE, I hereby expressly give my permission for my photograph or likeness to be used by Coastline Adventures Surfing School and/or Billabong for promotions, advertising or feature articles in any print or electronic medium. (Initial Here __________)
5) INDEMNITY. I hereby agree to INDEMNIFY AND SAVE AND HOLD HARMLESS the releasees and each of them FROM ANY LOSS,
LIABILITY, DAMAGE OR COST, that may incur arising out of or related to the use of any water sport equipment provided to me, arising out of or related to my participation in any water sports or water recreational activity, WHETHER CAUSED BY THE NEGLIGENCE OF
THE RELEASEES OR OTHERWISE. (Initial Here __________)
6) WAIVER OF LIABILITY. I HAVE READ THIS ASSUMPTION AND ACKNOWLEDGEMENT OF RISKS, RELEASE OF LIABILITY, AND
INDEMNITY AGREEMENT, I UNDERSTAND THAT BY SIGNING THIS DOCUMENT, I AM WAIVING VALUABLE RIGHTS, INCLUDING ANY
AND ALL RIGHTS I MAY HAVE AGAINST THE RELEASEES, THE OPERATOR NAMED ABOVE OR THEIR EMPLOYEES, SERVANTS,
AGENTS, VOLUNTEERS OR ASSIGNS AND INTEND MY SIGNATURE TO BE COMPLETE AND UNCONDITIONAL RELEASE AND
INDEMNITY TO THE GREATEST EXTENT ALLOWED BY THE LAW. (Initial Here __________)
NOTICE: Lessons and rentals may be terminated due to inclement weather, potential for lightning strikes or other actions of the ocean COASTLINE ADVENTURES believes are harmful to the student, renter, children, invitees, guests or others. A rain check will be provided in this case. (Initial Here_________)
COASTLINE ADVENTURES reserves the right to terminate a lesson or rental at any time should the student or renter, children, invitees, guests or others miss-use the equipment, endanger themselves or endanger others or show incapability of handling/controlling equipment or show incapability to listen to their instructor and follow safety rules. If lesson or rental if terminated due to this paragraph, a refund will not be due. (Initial Here __________)
SURFER’S OR GUARDIAN’S SIGNATURE: ______________________________________________________________
AGE: (MUST BE OVER 18) _____________________ DATE: __________________________________________
RULES: STAY OUT OF MARKED SWIM AREAS ∙ LOOK-OUT FOR & AVOID SWIMMERS ∙
FOLLOW INSTRUCTIONS OF LIFEGUARDS & INSTRUCTORS ∙ STAY WITHIN BOUNDARIES ∙ WATCH FOR INCLEMENT
WEATHER, COME IN IMMEDIATELY ∙ USE OF ALCOHOL AND DRUGS IS PROHIBITED
P.O. BOX 1274, NORMANDY BEACH, NJ 08739 732-300-5115 njsurfschool.com