Parents or Guardians (fill out if under 21 years old)
Father Name
Home Phone Work Phone

Mother Name
Home Phone Work Phone

In case of emergency, please contact:

Contact Name
Contact Phone

Release of Liability:

I agree to indemnify, defend, hold harmless and release Surfari Surf School, the City of San Diego, its elected and appointed officials, agents, employees, and volunteers from any and all lawsuits, damages, claims, judgments, losses, liability or expenses arising out (1) the death or personal injury or property damage to, myself, my child or my ward, which may be sustained while using property owned by or under the control of Surfari Surf School and the City of San Diego, or (2) any death or injury which results or increases by any action taken to medically treat me, my child, or my ward. All of the terms above shall apply whether or not caused by the alleged negligence, whether active or passive, or any acts or omissions of Surfari Surf School & the City of San Diego, or any of its elected or appointed officers, agents, employees, or volunteers".

I have read, understand and approve this Release From Liability. If the participant is a minor, the undersigned parent or legal guardian warrants and represents that this Release, its significance and the assumption of risk, has been explained to and understood by my minor child or ward. I hereby declare, under penalty of perjury, that I am the parent or legal guardian of the named participant.