Surfers Healing

Puerto Rico --Surfers Healing

April 9th and 10th 2010

Name of Child
Name of Parent
Address
City
State
Zip Code
Email
Telephone
Age of Child	yrs
Weight of Child
Have you ever been to a Surfers Healing camp ?	Yes No
Any special Information
Please pick 1st choice you want to attend	April 9th (11-3) April 10th (11-4)
Please pick 2nd choice you want to attend	April 9th (11-3) April 10th (11-4)

Please note family will get confirmation e-mail from Jennifer with confirmed surf time and surf date for your child.

******PARENT MUST STAY WITH CHILD******

*****Lunch will be provided for the entire family********

Any questions about surfers healing surf camp please e-mail Jennifer@surfershealing.org or izzy@surfershealing.org
or call 1-866-647-HEAL. Once we recieve your application we will send you a confirmation e-mail with your childs surf time.