Online Form The following online form is to be filled out before your trip. Contact InformationFirst Name*Last Name*MIDate of Birth* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Email* Enter Email Confirm Email Telephone*SkypeEmergency Contact InformationName*Relation to Participant*Email* Telephone*Sober Surf Program: ASSUMPTION OF RISK AND RELEASETHIS IS A RELEASE OF LEGAL RIGHTS -- READ AND UNDERSTAND BEFORE AGREEING. I hereby agree as follows: Risks of Participation In Abroad Programs I understand that participation in the Sober Surf program specified above involves risks. These include, but are not limited to, all activities during the program, risks involved in traveling to and within, and returning from, one or more foreign countries; foreign political, legal, social, and economic conditions; different standards of design, safety and maintenance of buildings, public places and conveyances; local medical and weather conditions. I have made my own investigation and am willing to accept these risks. Institutional Arrangements I understand that the program does not represent or act as an agent for, and cannot control the acts or omissions of, any host institution, transportation carrier, hotel, tour organizer or other provider of goods or services involved in the program. I understand that Sober Surf is not responsible for matters that are beyond its control. I hereby release the program from injury, loss, damage, accident, delay or expense arising out of any such matters. Independent Activity I understand that Sober Surf is not responsible for any injury or loss I may suffer when I am traveling independently or am otherwise separated or absent from any Sober Surf activities. I acknowledge and understand that my participation in the program is entirely voluntary. Health and Safety I understand that foreign travel and stay in a foreign country can provide special challenges and stresses. Medical care, including mental health care, emergency medical care and medicine may not be as available and/or of a quality comparable to that available in the United States. Participants with previous or current medical and/or mental health conditions are strongly encouraged to consult with trained medical and/or mental health professionals and to prepare strategies that may be used abroad should they experience problems. I acknowledge that I have been strongly encouraged to assess my ability to participate in the program and have done so. I am aware of all applicable personal medical needs. I have arranged, through insurance or otherwise, to meet any and all needs of payment for medical costs while I participate in the program. I recognize that Sober Surf is not obligated to attend to any of my medical or medication needs, and I assume all risk and responsibility therefore. If I require medical treatment or hospital care, in a foreign country or in the United States, during the program, Sober Surf is not responsible for the cost or quality of such treatment or care. The administrators supervising Sober Surf may (but are not obligated to) take any actions they consider to be warranted under the circumstances regarding my health and safety. I agree to pay all expenses relating thereto and release Sober Surf from any liability for any of its actions or inactions. Standards of Conduct. I understand that each foreign country has its own laws and standards of acceptable conduct, including dress, manners, morals, politics, drug use and behavior. I recognize that behavior which violates those laws or standards could harm Sober Surf’s relations with those countries and the institutions therein, as well as my own health and safety. I will become informed of, and will abide by, all such laws and standards for each country to or through which I will travel during the Program. I will also comply with the Sober Surf program’s rules, standards and instructions for participant behavior, especially in terms of surf safety and instruction as provided by Safari Surf School instructors. I am solely responsible for any legal problems I encounter with any foreign nationals or government of the host country. Sober Surf is not responsible for providing any assistance under such circumstances. Program Changes. Sober Surf has the right to make cancellations, substitutions or changes in case of emergency or changed conditions or in the interest of the overall program and its participants. I understand that If I leave or am asked to leave Sober Surf for any reason, there will be no refund of fees already paid. I understand that if the program does not meet participation requirements by January 30th, 2017, I will be refunded my initial deposit, but that this deposit is otherwise nonrefundable. I understand that Sober Surf will inform me no later than February 15th, 2017 if there is any possible cancellation to the program due to enrollment. I also understand that my choice to make airline ticket purchases prior to receiving official notice of program confirmation will be done at my own risk and Sober Surf will not be liable for any costs incurred in relation to travel purchases. Assumption of Risk and Release of Claims. Knowing the risks described above, and in consideration of being permitted to participate in Sober Surf, I agree, on behalf of myself, my family, heirs, and personal representative(s), to assume all the risks and responsibilities surrounding my participation in the program. To the maximum extent permitted by law, I release and indemnify Sober Surf, and its officers, employees and agents, from and against any present or future claim, loss or liability for injury to person or property which I may suffer, or for which I may be liable to any other person, during my participation in the Program (including periods in transit to or from any country where the Program is being conducted). I have carefully read this Release Form before signing it. No representations, statements, or inducements, oral or written, apart from the foregoing statement, have been made. This agreement shall become effective only upon receipt of my application by Sober Surf.Terms of Legal Conditions Agreement* I have read and agree to the terms of the Assumption of Risk and Release conditions laid out on this form. Emergency Consent, Allergies and Dietary RestrictionsAllergies. I am allergic to the following:*(Please note that if you carry an epi pen, you must alert the director of Sober Surf in regard to what conditions you may need an epi pen to be administered if you are not able to do so yourself and where the epi pen will be carried).Dietary Restrictions. I have the following dietary restrictions:*Emergency Consent Treatment Part 1* The following form gives permission for you as a participant in the Sober Surf program to be treated by a hospital or physician in case of an emergency. Emergency Consent Treatment Part 2* I, the undersigned, state that in the case of any emergency, the director of the Sober Surf program or any assistants therein may assent to emergency medical treatment if I am not capable of doing so on my own. This iframe contains the logic required to handle AJAX powered Gravity Forms.