LESSON TYPE*

Private 1:1 Lessons

Private Group Lessons

After School Surf Programs

Private Surf Video Analysis

Other (Please specify below)

School Surfing Programs

SKILL LEVEL *

Beginner

Intermediate

Advanced

Participate age

Please mark if any participants are under 12 yrs old (Primary School)

Under 12 y/o

Preferred Date

MM

DD

YYYY

Name *

First Name

Last Name

Phone *

(###)

###

####

Location Availability *

(Please Click Location Availibility)

Inverloch Surf Beach

Smiths Beach - Phillip Island

Cape Paterson First Surf Beach

Extra After School Program Info

After School Week Day Availability *Please Tick Days

Monday

Friday

Wednesday

Thursday

Friday