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LESSON REGISTRATION FORM

Full Name*

Email Address*

Phone Number*

Age*

Height & Weight*

Size (S, M, L, XL, XXL)*

Allergies, Recent Injuries, Medical Conditions*

Card Type (VISA, Master Card, AMEX, Discover)

Full Name On Card

Card #

Expiration Date

C V V (Code In The Back, Usually 3-4 Digits)

Full Billing Address & Zip Code

Parents Full Names & Phone Numbers (If Participant Is A Minor)

Notes & Description Of What Is Being Booked

TO HOLD A RESERVATION, WE NEED TO HAVE A CARD ON FILE.

HOWEVER, WE DO ACCEPT OTHER PAYMENT METHODS SUCH AS VENMO, Apple Pay, CASH OR CHECK.


TO PAY BY VENMO:

@HeavenOnEarthSS


TO PAY BY Apple Pay:

310-993-2298


PLEASE LET US KNOW IF YOU HAVE YOUR OWN EQUIPMENT AND PLAN TO BRING IT FOR YOUR LESSON.

(WETSUIT, SURFBOARD, PADDLE BOARD)

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