Sababa LA Registration

Sababa LA- Registration
Please complete this form and submit your payment to hold your space for an incredible experience surfing, spirituality and fun!

Surfer's Name

Surfer's Cell Phone Number

Surfer's Grade in School

Address

Parent/Guardian 1 Name

Parent/ Guardian1 Cell Phone Number

Parent/Guardian 2 Name

Parent/Guardian 2 Cell Phone Number

Please select your session(s):

Monday, April 2‎ Tuesday, April 3‎ Wednesday, April 4‎

Please select your pick up location.

Walgreens Parking Lot on Pico Blvd. and Robertson Blvd. at 8:15 AM (8770 W Pico Blvd. Los Angeles, CA 90035)‎ El Camino Shopping Center (in front of Health Nut) at 8:45 AM (23373 Mulholland Dr. Woodland Hills, CA 91364)‎ I am not sure yet and will confirm later.‎

Does your child have any allergies/ conditions? (If yes, are they life threatening, and what is your action plan?)
Please indicate "None" if not applicable.

Is your child on any medications? If yes, please provide the name of medication, and the dosage/time.
Please indicate "None" if not applicable.

What was the date of your child's last physical exam?
Please indicate Monday/Year

Are all vaccinations up to date?
Yes/No (If No, please explain)

Please provide us with your physicians name, phone number and address:

I am enrolling my Surfer in the Sababa LA program.

I agree to the consent

Program Evaluation Release

I agree to the program evaluation release

Surfer Code of Conduct

My child will adhere to the Sababa Code of Conduct

Photo Release

I agree to the photo release

By typing your name here, you are signing this application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this application.

Today's Date

FOR OFFICE USE ONLY

Session 1: June 26th - June 30th Session 2: August 7th - 12th (includes overnight Shabbaton) Session 3: August 14th - 19th (includes overnight Shabbaton Session 4: August 21st-25th Session 5: August 28th - 31st