Phillip Island Sign Up Form • Christian Surfers Australia

Participant Info

First Name

Last Name

Preferred Name

Mobile Number

Email Address

Date of Birth

Describe your surfing ability

I don't surf but I love the ocean

I'm a beginner

I can hold my own

Experienced

Describe your current faith position

I don't want to be a Christian but I enjoy coming to CS

Don't know what Christianity is but I like CS

I know a bit about God but still unsure

I'd like to know more about what it means to be a Christian

I believe in Jesus

I'm a committed Christian actively serving in my faith community

Medical Info

Do you have any medical conditions we need to be aware of?

Do you have any dietary requirements? *

Yes

Medicare Number *

Do you have private health care? *

Parent / Guardian Details

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Email

Parent/Guardian Mobile

Permissions and Indemnity

Whilst I realise all due care will be taken , I the parent/guardian, indemnify Christian Surfers Australia and its leaders against any claim made on behalf of the above participant arising out of any injury sustained during CSA events. I accept that participation in CS events is done at the individuals own risk. I accept that Christian Surfers will assess conditions and will not force the participant to surf in conditions they are not comfortable with. I also give Christian Surfers permission to seek any medical treatment for the above participant in the event of any injury if I cannot be contacted. I indemnify Christian Surfers Australia against any loss or damage of the participants personal property during CS events.

I agree to the above statement and indemnify CSA *

Yes I indemnify CSA

No I do not indemnify CSA

Do you consent to CSA using pictures you may be in, within its communication and promotion via email or Social Media? *

Are you happy for us to collect and store your information for CSA purposes? We do not share any personal information with any other entities. *

Yes

Do you wish to receive email updates from CSA? *

Yes