Book A Session!

Please fill out the form below for review and click on “sign our waiver” below (bottom right). If you are a good fit for Surfing for Empowerment surf lessons you will be contacted shortly. If you have questions, please call (760)846-6894

Are you: *
San Diego localvisiting from out of town

First Name: *

Last Name: *

Email: *

Daytime Phone:

Evening Phone:

Preferred date/day of first lesson:

General availability:

Your surfing experience level? *

How would you describe your swimming ability? *

Do you need a surfboard?

YesNo

Do you need a wetsuit?
(Water temperature ranges from 68-72 degrees from May through September.)

YesNo

Height (for proper board and wetsuit fit):

Weight (for proper board and wetsuit fit):

What is it you hope to get out of this Surfing for Empowerment session?*

Please choose 3 of the following growth areas that appeal most to you:*

SurrenderRelaxationTrustDiscernmentCourageAcceptanceAmbition
Present Moment AwarenessAlivenessSuccessFlow/Grace

What about Surfing for Empowerment appeals to you?*

Anything else I need to know including surfing experience, special needs, etc?

Yes subscribe to my newsletter for FREE valuable surf info and updates!

Please Prove You Are Human!




Now please click on “sign our waiver” on bottom right. You must hold down and move the cursor in order to sign your name and then click on the link in your e-mail to verify. Each adult must sign their own waiver. All minors under 18 must have a parent or guardian sign for them and and can be included in adults waiver if they are participating in lesson together.

 


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***Please Note: No refunds possible after 30 days of deposit date