Please list the names of people who are allowed to pick up or check out the participant (other than those listed above as parents/guardians or emergency contacts).
Please list any medical concerns and/or problems, including any requiring maintenance medication (i.e. Diabetic, Asthma, Seizures)
Please list any medical conditions that our staff should be aware of.
Is the participant presently being treated for an injury or sickness, or taking any form of medication for any reason?
Is the participant allergic to any type of food or medication?
Does the participant require a special diet?
PHOTO, VIDEO & MEDIA RELEASE *
I hereby give permission for the participant to be photographed and/or filmed during the program, camp, course, clinic or activity. I understand the photos may be used for training purposes, shared as promotional materials (including flyers, brochures, in print, on the internet, etc.), or used in curriculum. I understand that although the participant's photo or video may be used for promotion, his or her identity will not be disclosed without permission; I do not expect compensation and that all photos and video are the property of Surf Education Academy. If you do not want imagery of the participant used for promotional reasons, please let us know in writing and we will not feature images with named participants as the focal point; however, participants may appear in the background of other imagery.