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JC Surf Camp Sign Up Form

Selected Camp:

Availability Dates Camp Name Ages Deposit Total Price
Open 8/7/17 - 8/11/17 8-10AM Teen Camp 13-17 $50.00 $255.00

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Camper Information

mm/dd/yyyy

Camper's grade in school. ex: 5th

Camper's age when attending camp.

ex: 4' 11"

ex: 130 lbs

COUNTY OF NEW HANOVER

STATE OF NORTH CAROLINA

RELEASE OF LIABILITY ASSUMPTION OF RISK AND INDEMNITY AGREEMENT

I, THE PARENT/LEGAL GAURDIAN of this minor, acknowledge that I have voluntarily applied to the JC Surf Camp for my child's participation in surfing and swimming instruction and related activities to be conducted on the shore and in the open water at various beach locations in the County of New Hanover and State of North Carolina.

I AM AWARE THAT SURFING, SURFING INSTRUCTION, AND THE RELATED ACTIVITIES OFFERED BY THE CAMP ARE POTENTIALLY HAZARDOUS ACTIVITIES. I AM VOLUNTARILY AUTHORIZING MY CHILD'S PARTICIPATION IN THESE ACTIVITIES WITH KNOWLEDGE OF THE DANGER INVOLVED, AND HEREBY AGREE TO ASSUME ANY AND ALL RISKS OF BODILY INJURY OR DEATH ARISING FROM THESE ACTIVITIES.

As consideration, in part, for being permitted by JC Surf Camp, Inc. to participate in these activities, I do:

HEREBY RELEASE, WAIVE, DISCHARGE, AND AGREE TO HOLD HARMLESS JC Surf Camp, Inc., its facility, or any of its officers, instructors, agents or employees FROM ALL LIABILITY TO MYSELF, my personal representatives, heirs and assigns, and next of kin FOR ANY AND ALL LOSS OR DAMAGE, AND ANY CLAIM OF DEMANDS THEREOF ON ACCOUNT OF INJURY TO MY PERSON OR PROPERTY OR RESULTING IN MY DEATH, NOW AND FOREVER, ARISING OUT OF OR RELATED TO MY PARTICIPATION IN THIS ACTIVITY THAT MAY OCCUR, WHETHER CAUSED BY THE NEGLIGENCE OF JC Surf Camp, Inc., OR OTHERWISE, and

HEREBY, ASSUME FULL RESPONSIBILITY FOR ANY RISK OF BODILY INJURY, DEATH OR PROPERTY DAMAGE, now and hereafter, and

HEREBY SEPARATELY agree to INDEMNIFY and SAVE and HOLD HARMLESS JC Surf Camp, Inc., its facility, or any of its officers, instructors, assistants, agents or employees from any and all loss, liability, damage or cost that they may incur now and hereafter, arising out of or related to participation in this activity, whether caused by the negligence of JC Surf Camp, Inc. or otherwise, and

HEREBY acknowledge that INJURIES RECEIVED MAY BE COMPOUNDED OR INCREASED BY NEGLIGENT RESCUE OPERATIONS OR PROCEDURES OF JC Surf Camp, Inc. and agree that this Waiver and Release of Liability, Assumption of Risk and Indemnity Agreement extends to all acts of negligence by JC Surf Camp, Inc., INCLUDING NEGLIGENT RESCUE OPERATIONS.

I understand the camp retains the right to use photographs of campers taken at camp for publicity and advertising purposes, and hereby release JC Surf Camp, Inc. from all liability regarding the same.

I HAVE READ this Release of Liability, Assumption of Risk and Indemnity Agreement, and fully understand its terms. I understand that I have given up substantial rights by signing this document, am aware of its legal consequences, and have signed it freely and voluntarily without any inducement, assurance or guarantee being made to me and intend my signature to be a complete and unconditional release of all liability to the greatest extent allowed by law. I have had the opportunity to personally discuss and realize the potential dangers incidental to engaging in surfing, open water swimming, and related instruction activities and exercises whether on land or in water.

IN WITNESS WHERE OF, I HAVE HERE UNTO PLACED MY HAND AND MY SEAL THIS DAY.

Payment Information

This is the 3 digit number on the back of your credit card.
For American Express the number is 4 digits and is on the front of the card.

Billing Address
United States

$50.00 Deposit, to be charged now.

The remaining: $205.00, will be due one week before camp.





For more information please call us at 910-622-5272 or send an email to info@jcsurfcamp.com