Spring Cabo Camp Registration | Paskowitz Surf Camp

This application provides you (18+ yrs only) with an exclusive opportunity to enroll for Spring Cabo Camp. Please complete the online application, and send a $500.00 deposit per person. Once processed, the remaining balance owed will be confirmed via email.

*Please note: Deposits must be received within 14 days from the submission date in order to secure your space. VISA/ MC/ AMEX are accepted (subject to a 3.5% processing fee) by contacting Danielle Paskowitz via email at DaniellePSC@aol.com or by calling (949) 728-1000. Balance due must be paid by check.

Camper Information

First Name *

Last Name *

Nickname

Birth Date

Month

Day

Year

Gender

Street Address *

Street Address Line 2

City *

State/Province *

Postal Code *

Country *

Email *

Phone Number (Home)

Phone Number (Mobile)

Height

Weight

Is this your first time attending Paskowitz Surf Camp?

Yes

Year(s) attended

T-Shirt Size

Additonal Information

Please note ANY special information that we should be aware of, i.e. medical issues, required medication, allergies, and special needs with regards to diet, special social or physical needs:

Registration Fee $ per person

Insurance Information

Insurance Carrier

Policy Number

Physician Information

Prefix

First Name

Last Name

Phone Number

Emergency Contact

First Name

Last Name

Phone Number (Home)

Phone Number (Work)

Ext.

Phone Number (Mobile)

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