The City of Jacksonville Beach

The City of Jacksonville Beach Presents: “The 14th Annual Super Surf Camp 2013”

REGISTRATION FORM “SUPER SURF CAMP 2013” Applications are available at the City of Jacksonville Beach Parks & Recreation Department, or online at www.jacksonvillebeach.org under “Kids Camps.” Applications are also available at our official sponsor, Sunrise Surf Shop, 834 Beach Blvd., Jacksonville Beach, FL, and www.sunrisesurfshop.com under “Shop News.”

Registration opens April 1,2013at Sunrise Surf Shop 9am-5pm. All applications must be returned to the City of Jacksonville Beach Parks & Recreation Department, or to Sunrise Surf Shop. *Note: you may only register for ONE week (You may only sign up your child plus one) *** All beginners ages 8 (as of June 1 st ) & up are welcome. First come, first serve Only 50 spots per camp available—so sign up soon!*** Camps run from 8:30-11:30 a.m. at 8th Ave. N. oceanfront. The dates for each session of this summer’s Surf Camps are as follows  Camp #1: June 10-June 14  Camp #2: June17 -June 21 COST: $180 per session CANCELLATION POLICY: A two-week notice must be given to receive a full refund. Anything less will constitute a deduction of $75.00 from the refund. No exceptions. INCLUDES: One (1) cool t-shirt, bag of surf goodies, and use of beginner’s board and kayaks. PAYMENT: CASH OR CHECK ONLY. No credit cards accepted. Please make checks payable to: City of Jacksonville Beach. Fees must be PAID IN FULL at the time of registration and enclosed along with your completed application.

For more information contact the City of Jacksonville Beach Park Recreation Department 247-6236 or Sunrise Surf Shop, 241-0822.

NOTES:  The “Super Surf Camp 2013” is presented solely by the City of Jacksonville Beach; Sunrise Surf Shop is merely the official sponsor. Sunrise Surf Shop may provide staff and/or equipment to be used at the “Super Surf Camp 2013,” but all such staff and/or equipment are under the exclusive direction and control of the City of Jacksonville Beach.  Sunrise Surf Shop makes no representations, guarantees, warranties, or affirmations about the quality, safety, or appropriateness of the instructors, equipment, or educational content of the “Super Surf Camp 2013.”  All participants must be competent ocean swimmers.  Due to safety requirements, if a hard board is brought to camp, our instructors will have the final say if it can be used during camp.  Soft boards will be provided to you for the camp at no charge.  Any 4 out of 5 days will constitute a full camp.  Please have your child at camp on time.  *DOGS are prohibited on the beach between 9 a.m. and 5 p.m., so please—do not bring your dogs with you.

**All proceeds generated by “The 14th Annual Super Surf Camp 2013” registration fees go back into Camp resources or to the City of Jacksonville Beach Ocean Rescue Division**

1 “SUPER SURF CAMP 2013” WAIVER AND RELEASE OF LIABILITY In consideration for my minor child being allowed to participate in the “Super Surf Camp 2013” and its related events and activities, I, the undersigned agree to and acknowledge the following: 1. That I am the parent or legal guardian of the below named minor child, that I have the legal right to make decisions on behalf of and for the child, and that I wish to exercise my rights to make such decisions on behalf of and for the child by electing to enter the child in the “Super Surf Camp 2013.” 2. That prior to having my child participate in the “Super Surf Camp 2013,” I will have the opportunity to inspect the facilities and equipment being used, and also to question the instructors and staff who are participating in the “Super Surf Camp 2013.” Should I discover anything that I believe is unsafe, I will not permit my child to participate in the “Super Surf Camp 2013,” and I or my child will immediately advise the instructors or staff of the unsafe condition(s). 3. That each participant will be engaging in activities that involve risk of serious injury, including but not limited to permanent disability or death, and severe social and economic losses which might result not only from their own actions, inactions, or negligence, but also from the action, inaction, or negligence of others, or the conditions of the ocean or beach or of any equipment that is used. Further, that there may be other risks not known to us or not reasonably foreseeable at this time. 4. That the “Super Surf Camp 2013” is presented solely the City of Jacksonville Beach, and that Sunrise Surf Shop is merely the official sponsor. I further understand and agree that all staff (including but not limited to instructors) and equipment used at the “Super Surf Camp 2013” are under the exclusive custody and control of the City of Jacksonville Beach. Further, in having my minor child participate in the “Super Surf Camp 2013,” I am not relying upon any representations, guarantees, warranties, or affirmations from Sunrise Surf Shop about the quality, safety, or appropriateness of the instructors, equipment, or educational content of the “Super Surf Camp 2013.” 5. That I assume all the foregoing risks and accept personal responsibility for the damages following any such injury, permanent disability, or death. 6. That I release, waive, discharge, and covenant not to sue The City of Jacksonville Beach or the “Super Surf Camp 2013’s” official sponsor (T.D. Brooks, Inc. d/b/a Sunrise Surf Shop, Treco Brooks, LLC, and T. Daniel Brooks), their agents, employees, and successors-in-interest or assigns, other participants in the “Super Surf Camp 2013,” and any other sponsoring agencies (either public or private) from any and all liability to the undersigned and the undersigned’s child, their heirs and next of kin, for any and all claims, demands, losses or damages on account of injury, including but not limited to personal injuries, death, or property damage, caused or alleged to have been caused in whole or in part by the negligence of The City of Jacksonville Beach or the “Super Surf Camp 2013’s” official sponsor (T.D. Brooks, Inc. d/b/a Sunrise Surf Shop, Treco Brooks, LLC, and T. Daniel Brooks), their agents, and employees, other participants in the “Super Surf Camp 2013,” and any other sponsoring agencies (either public or private). I HAVE READ THE ABOVE WAIVER AND RELEASE, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS ACCRUING TO MY CHILD AND ME, AND SIGN IS VOLUNTARILY. Name of Participant: (Print) ______

Name of Parent/Guardian: (Print)______

Telephone Numbers of Parent/Guardian: Home: ______

Work: ______Cell: ______

Signature of Parent/Guardian: ______

2 PARTICIPANT INFORMATION (Please print)

PLEASE CIRCLE ONE: MALE FEMALE Camp #1: June 10-June 14 Camp #2: June 17 -June 21

Name: ______Age:______

Address: ______City: ______Zip:______

Cell No.: ______Home No.: ______Work No: ______

Parent name: ______Email______

In case of emergency, please notify: ______

Relationship: ______Phone: ______Cell: ______

Doctor’s name: ______Phone: ______

Any pertinent medical problems we should be made aware of? _____ No_____ Yes If yes, please explain:

______

Is applicant on any prescribed medication(s): _____ No_____ Yes If yes, please explain:

______

T-SHIRT SIZE: (Check one) _____ YOUTH-LARGE

_____ ADULT-SMALL

_____ ADULT-MEDIUM

_____ ADULT-LARGE

_____ ADULT-EXTRA LARGE SPECIAL REQUEST If your child would like to be in the same group with a friend, PLEASE REQUEST HERE Friend’s name______

Our goal is to provide quality surfing and safety instructions for each camper by experienced surfers, lifeguards, and paramedics. We will be focused on giving our campers a solid base of surfing knowledge so they will be able to enjoy this wonderful sport for the rest of their lives.

Acknowledgement: Jimmy Wilkins, Superintendant, Parks & Recreation/Ocean Rescue The City of Jacksonville Beach, Florida

3 City of Jacksonville Beach

DEPARTMENT OF RECREATION, PARKS & OCEAN RESCUE

2508 South Beach Parkway. Jacksonville Beach, Florida 32250

Phone: (904) 247-6236 ~~ Fax: (904) 247-6143 14TH Annual Super Surf Camp

DISCLAIMER / HOLD HARMLESS / IDEMNIFICATION AGREEMENT

NOTICE FOR ADULTS and MINOR CHILDREN’S NATURAL GUARDIANS

READ THIS FORM COMPLETELY AND CAREFULLY.

You are agreeing to let yourself and or your minor child engage in a potentially dangerous activity. You are agreeing that even if the City of Jacksonville Beach Parks and Recreation Department and the City of Jacksonville Beach uses reasonable care in providing this activity, there is a chance you and or your child may be seriously injured or killed by participating in this activity because there are certain dangers inherent in the activity which cannot be avoided or eliminated.

By signing this form you are giving up your child’s, and or your right and your right to recover from the Jacksonville Beach Parks and Recreation Department, the City of Jacksonville Beach and its employees in a lawsuit for any personal injury, including death, to you and or your child or any property damage that results from the risks that are a natural part of the activity. You have the right to refuse to sign this form and the city of Jacksonville Beach Parks and Recreation Department and the City of Jacksonville Beach has the right to refuse to let you and or your child participate if you do not sign this form.

Upon acceptance of this entry form, the undersigned parent/guardian of (print name of participant )______hereby agrees to hold harmless and indemnify the City of Jacksonville Beach, T.D. Brooks, Inc. d/b/a Sunrise Surf Shop, Treco Brooks, LLC, and T. Daniel Brooks, their agents and employees, other participants in the “Super Surf Camp 2013,” and any other sponsoring agencies (either public or private) for all losses incurred (including but not limited to damage awards or settlements, defense attorney’s fees and costs of litigation) as a result of any claims or lawsuits made against the City of Jacksonville Beach, T.D. Brooks, Inc. d/b/a Sunrise Surf Shop, Treco Brooks, LLC, and T. Daniel Brooks, their agents and employees, other participants in the “Super Surf Camp 2013,” and any other sponsoring agencies (either public or private) by or on behalf of the above-noted participant.

I have read and understand the terms of this Release.

______

Adult Participant Name /Parent or guardian of minor(s) name (please print)

______Date: ______

Adult Participant /Parent or guardian of minor(s) (signature)

Photographic Waiver: I, (Print) ______, as the parent or legal guardian of the above-noted participant in the “Super Surf Camp 2013,” hereby give my permission to the City of Jacksonville Beach to take photographs for the duration of the Surf Camp. I understand that these may be used for promotional material, but will not be used for the purpose of profit.