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SURF SCHOOL WALES cic

GIFT CARD
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MEDICAL FORM

Every customer must complete this medical form.

First Name

Last Name

Date of Birth

Phone

Email

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

I agree to theterms & conditions

I confim I am able to swim

Do you have any medical conditions

Name of emergency contact

Contact number for emergencies

Date of your lesson

Thanks for submitting!

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