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The Waiver
Main Contact Name
(Required)
(Parent/guardian if participant is a minor)
First
Last
Phone
(Required)
Email
(Required)
Address
(Required)
Street Address
City
State / Province / Region
ZIP / Postal Code
Afghanistan
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Anguilla
Antarctica
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Austria
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Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
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Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
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Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
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Egypt
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Equatorial Guinea
Eritrea
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Eswatini
Ethiopia
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Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
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Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
I am completing this application for:
(Required)
Myself
A Minor
Participant's Age
(Required)
Does this participant have physical, mental, and/or special needs which may affect his/her ability to surf?
(Required)
Yes
No
Please explain
Consent for Minor's Participation
(Required)
FOR PARTICIPANTS OF MINORITY AGE: This is to certify that I/we, as parent/guardian, temporary guardian with legal responsibility for this participate, do consent and agree not only to his/her release of all releases, but also to release and indemnify the releases from any and all liabilities incident to his/her involvement in these programs for myself, by heirs, assigns, and next of kin.
I agree
Initial of Parent or Guardian
(Required)
Fitness to Surf
(Required)
DECLARATION OF FITNESS TO SURF: I/We declare that I/We are physically fit. I/we do not, and have not suffered from any of the following conditions, which I/we understand my lead to a dangerous situation with regard to other persons or myself/ourselves during riding activities: Epilepsy fits, severe head injury, recurrent blackouts or giddiness, disease of the brain or nervous system, high blood pressure, lung or heart disease, recurrent weakness or dislocation of any limb, diabetes, mental illness, drug or alcohol addiction, recent back injury, arthritis and severe joint sprains, chronic bronchitis, asthma, rheumatic fever, thyroid, adrenal or other glandular disorder, recent blood donation, or any condition that requires the regular use of drugs. I/we hereby declare that I/we have no physical or mental conditions that should preclude me/us from participating in my/our chosen activity, that I/we am not participating against medical advice or treatment and that I/we have not been diagnosed by a registered doctor as having a terminal illness. I further declare that in the event that I/we feel ill or unwell, have any physical complaints whatsoever or is an injury is sustained of any kind during the course of surfing activities, I/we will notify the instructor/guide/employee, of the insured immediately and before moving away from the immediate vicinity.
I agree
Initial
(Required)
SURF CAMP RELEASE OF LIABILITY, WAIVER OF CLAIMS, AND EXPRESS ASSUMPTION OF RISK AND INDEMNITY AGREEMENT
(Required)
By signing this waiver, I intend to be legally bound and acknowledge that the possibility of my child/myself being injured while attending
PEAKSNSWELLS Surf Camp (P&S Surf Camp SRL)
, therefore I understand and assume all risks, including but not limited to death, injury or illness from accidents of any nature whatsoever, whether severe or not which may occur as a result of being part of
PEAKSNSWELLS Surf Camp (P&S Surf Camp SRL)
or travelling by car, bus or any other means to
PEAKSNSWELLS Surf Camp (P&S Surf Camp SRL)
activities; death, injury or illness including food poisoning arising from the provision of food or beverage by
PEAKSNSWELLS Surf Camp (P&S Surf Camp SRL)
, local restaurants or other service providers, theft, loss or damage of personal property while in transit or participating in
PEAKSNSWELLS Surf Camp (P&S Surf Camp SRL)
activities.
Further by signing this agreement I am representing that I understand, comprehend and appreciate that surfing is inherently a potentially dangerous sport, that the ocean even in shallow portions or on seemingly calm days, is powerful and potentially dangerous because of, but not limited to currents, rip currents, tides,waves, rocks, and other objects, sea creatures and/or swimmers and surfboards which are inherently dangerous because of among other things their pointed tips, sharp edges and pointed fins, buoyancy, hard surfaces and leg ropes especially when placed in the ocean environment where they may be acted upon by the forces of the ocean, wind and other people.
This waiver is a release limiting the right to recover any damages in case of accident and must be signed by the participant to be admitted to
PEAKSNSWELLS Surf Camp (P&S Surf Camp SRL)
. By signing this waiver, I hereby intend to be legally bound and in addition, my heirs/executors/estate administrators to be bound, to hold harmless and release
PEAKSNSWELLS Surf Camp (P&S Surf Camp SRL)
and any institution from the Costa Rican Government, their employees, instructors and or agents from any responsibility or liability arising from injury and /or property damage. I further accept responsibility that my child, my dependant or myself are physically able to participate in
PEAKSNSWELLS Surf Camp (P&S Surf Camp SRL)
.
I also promise to inspect the beach and ocean conditions before I participate and thereafter while I am participating in any of
PEAKSNSWELLS Surf Camp (P&S Surf Camp SRL)
surfing instruction activities, and decline to participate, or stop participating, if I do not feel comfortable and confident in my ability to swim or surf in the prevailing conditions. However, I fully accept in advance that
PEAKSNSWELLS Surf Camp (P&S Surf Camp SRL)
has the right to refuse to provide me services related to surfing or participating in activities in the ocean, if in the opinion of
PEAKSNSWELLS Surf Camp (P&S Surf Camp SRL)
, the undersigned’s swimming abilities, health or the prevailing weather conditions could render it dangerous or unsafe to use such services. Additionally, in the event that I cannot be reached in a medical emergency, i hereby give permission to the physician, lifeguard, medical aide, or staff person selected by
PEAKSNSWELLS Surf Camp (P&S Surf Camp SRL)
to secure proper treatment for my child, ny dependant or myself.
By signing this agreement I hereby clearly and unequivocally express my intent to release, discharge and hold
PEAKSNSWELLS Surf Camp (P&S Surf Camp SRL)
its members, managers, officers, directors, partners, joint venturers, volunteers, instructors and assigns from any and all claims or causes of action for compensation for physical injury or property damage arising out of or in any way connected with my participation in
PEAKSNSWELLS Surf Camp (P&S Surf Camp SRL)
activities even if such physical injury or property damage is caused by the partial negligance or even the sole negligence of
PEAKSNSWELLS Surf Camp (P&S Surf Camp SRL)
it members, managers, officers, directors, partners, joint venturers instructors or assigns. Finally by
I HAVE READ AND UNDERSTOOD THIS RELEASE AND INDEMNITY AGREEMENT PRIOR TO SIGNING THIS DOCUMENT, ANY DISPUTE ARISING OR IN CONNECTION WITH THIS AGREEMENT OR RELATED TO ANY MATTER WHICH IS THE SUBJECT OF THIS AGREEMENT SHALL BE SUBJECT TO THE EXCLUSIVE JURISDICTION OF THE COURTS LOCATED IN COSTA RICA AND UNDER THE COSTA RICAN LAW; CONSEQUENTLY BY SIGNING THIS AGREEMENT I AM AFFECTING THE LEGAL RIGHTS AND LIABILITIES OF MYSELF, MY HEIRS, NEXT OF KIN, EXECUTORS, ADMINISTRATORS AND ASSIGNS WITH REGARD TO
PEAKSNSWELLS Surf Camp (P&S Surf Camp SRL)
.
By signing below, i acknowledge that I have read and understand this release form.
Signature OR PARENT OR LEGAL GUARDIAN (IF UNDER 18 YEARS OF AGE)
I agree.
Signature of adult participant or parent/guardian if participant(s) is a minor
(Required)
Date
(Required)
MM slash DD slash YYYY
Phone
This field is for validation purposes and should be left unchanged.
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Camps
Family Surf Camp
Surfer Girl Camp
Custom Surf Camp
Classic Surf Camp
What’s Included
Surfing
Coaching
Food
Accommodation
Location & Breaks
Yoga
Activities
About Us
Photos
Press
Testimonials
Magazine
Trip Advisor Reviews
FAQs
Book Now
Contact Us