Fall Camp 2008



 

Full Name_______________________________________________________________ NICKNAME_________________________

Height _________________Weight __________________ Birthday_______-_______-______________ SEX_____M______F

is this your first year at PSC_____________________________If not what was____________________________________________

Circle T-Shirt size:  (Child) Sm Med Lg XL    or    (Adult)  Sm Med  Lg XL

Insurance Carrier_____________________________ Insurance Numbers_______________________________________________

Family Physician___________________________________________ Phone (      )______-_________________________________

Please note ant special information that we should be aware of (i.e. medical issues, medication, allergies, special needs, and/ or social/ physical conditions that require special attention). Please check: Medication Medical Condition Life-Threatening allergy
Allergy Asthma Special Needs Cardiac Condition Other Please ________________________________________

__________________________________________________________________________________________________________

__________________________________________________________________________________________________________

Briefly describe your  personality.(i.e. shy, outgoing, ect.) ______________________________________________________________

__________________________________________________________________________________________________________

Are there any special areas (i.e. activities, new friendships, surfing, ect.) __________________________________________________

__________________________________________________________________________________________________________

Address__________________________________________________________Home Phone_______________________________

City__________________________________ State______________ Zip________________________________________________

Occupation_________________________________________________________________________________________________

How, or from whom did you learn of Paskowitz (specify please) _________________________________________________________

Travel Information: PLEASE FORWARD ITINERARY

YES Bringing Surfboard ____________________________________________________________________________________

Surf Experience __________________________________________________________________________________________

Describe Your Swimming __________________________________________________________________________________


EMERGENCY INFORMATION:

Who is the emergency contact person in the event both parents are unavailable?

Name_____________________________________________Relationship____________________________________________

Phone Number Home________________________________Work____________________________________________________

 

Please check the camp(s) and weeks attending:

2008 Dates for Cabo San Lucas

Book Private May 14 to 20 October  October 

Price: $2,900.00

 
 

HOW TO ENROLL
Please complete both sides of this New Enrollment Application form, sign the form, and mail it with a $500 deposit per person to the mailing address below. Applications will also be accepted by fax. The balance of the tuition is due 4 weeks prior to camp. VISA/ MC/ AMEX are accepted for the deposit balance due must be by check.

FAMILY OR GROUP DISCOUNTS
A 5% family discount is given to all families enrolling two or more children. This discount applies to each child enrolled after the first in your immediate family. A 5% group discount is also available for each member of a group of four or more campers.  In order to receive this discount, all applications must be sent together in the same envelope. Please note: Only one discount applies per camper (i.e. family or group).

CANCELLATIONS AND CHANGES
If you need to cancel your child’s enrollment in camp, you must notify us in writing by April 1, 2008 in order to receive a refund. Cancellations on or prior to this date are subject to a $50 processing fee per child. No refunds will be given out after April 1, 2008 regardless of your registration date. Changes in the enrolled weeks are based upon availability. Full credit may be applied.

Checks payable to: Paskowitz Surf Camp send this form to: Paskowitz Surf Camp   P.O. Box 522 San Clemente, CA 92674
If you have questions or scheduling problems, call Danielle in the office at (949) 728-1000 or please feel free to call her cell at (949) 290-9420 FAX (949) 728-1200 Director Questions (949) 463-WAVE, Izzy Paskowitz.      

 
Deposit Visa/MasterCard/Amex (circle one) Name on card Expiration Date CHECK
500     ___/___/______