SURF SCHOOL WALES cic

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MEDICAL FORM

Every customer must complete this medical form for 2022 lessons. You only need to complete it once for the 2022 season. Under 16's must have this completed by parent/guardian.

First Name

Date of Birth

Phone

Email

I declare that the info I’ve provided is accurate & complete

I agree to theterms & conditions

Please send me news and offers

Last Name

Do you have any medical conditions

Name of emergency contact

Contact number for emergencies

Date of your lesson

Thanks for submitting!