Please note by completing this form you agree that you will not be under the influence of any mind altering medications, drugs, alcohol, marijuana, or any other substances that would impair your ability to participate in the activities you have signed up to participate in. Also by completing this form you agree to participate in all of the activities of the event you have signed up for to the best of your abilities and are allowed to barring any restrictions that must be kept for the safety of you, your family members, the staff, volunteers and partners of AmpSurf conducting the events.
You will be taken to the “Welcome to the family Page/Fundraising” page when you click the submit button. this means your form was submitted successfully.

AmpSurf 2019 Clinic intake form
This is the chapter that the participant has signed up to surf with. i.e York Beach, ME would be the New England Chapter.
We encourage all family members to surf as well. Please complete all the information on the this form to help us make sure you have a great time in the water as well.
So, we can make sure we have a beach wheelchair available for you.
Please note by completing this form you agree that you will not be under the influence of any mind altering medications, drugs, alcohol, Marijuana, or any other substances that would impair your ability to participate in the activities you have signed up to participate in. Also by completing this form you agree to participate in all of the activities of the event you have signed up for to the best of your abilities and are allowed to barring any restrictions that must be kept for the safety of you, your family members, the staff, volunteers and partners of AmpSurf conducting the events.

You will be taken to the “Welcome to the family Page/Fundraising” page when you click the submit button. this means your form was submitted successfully.