Kids for Clean Water Contest/May 22nd/Coronado

The Coronado Longboard Surf Club Presents:

Download contest flyer

The 1st annual

Kids for Clean Water Menehune Surf Contest

Sunday May 22, 2005

Please send completed application with a $15.00 check made out to Coronado Longboard Surf Club by May 19, 2005 to John Gillem 1 Pine Court, Coronado CA 92118. Contest begins at 8:00 am at the Coronado Shores Beach.

Sponsored by Coronado Surfing Academy, Wildcoast, Surfers Path, and Emerald City.

Name ________________________________________________________________

Age_____

Address ___________________________________________________________

City _______________________________State ______________ Zip Code_____________

Phone (_____)____________________ email address________________________________

Please circle your desired division:

Male Female 14-16 Longboard Shortboard

Male Female 11-13 Longboard Shortboard

Male Female 8-10 Longboard Shortboard

Male Female under 7 Longboard Shortboard

I, the undersigned being an adult, agree to assume all the risks for injuries arising out of my or my dependent’s participation in any activity sponsored by the Coronado Longboard Surf Club and make no claim whatsoever for injures against the Coronado Longboard Surf Club, its officers, other sponsors of the event, or agents by reason of my said participation, or the participation of my dependent. I understand that the person whose name appears on this registration form is voluntarily participating in the activity, and the Coronado Longboard Surf Club provides no insurance, and will not pay any medical expenses arising out of any injury associated with this event. I further represent that I, or my dependent, is physically able to participate in said activity. I acknowledge that I, or my dependent, voluntarily participate in the event at my own risk.

Signature (Parent or Guardian if under 18 years of age)_____________________________________

Date________________