Emergency Medical Authorization

Scholastic Surf Series (SSS) is a school-based surf competition program that gives students the chance to compete in organized surf events while representing their schools.

This is the 2nd part of the registration process.
If you haven't already, register and pay for membership at: surfsss.surfsignup.com, register, and pay.

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This field is for validation purposes and should be left unchanged.
Students Name*
First Last
Date of Birth*
MM slash DD slash YYYY
Surf Team*
Emergency Medical Authorization
Emergency Contact*
Phone*
HEALTH INSURANCE?
- YES, I HAVE INSURANCE
- NO, I DO NOT HAVE INSURANCE
Insurance Carrier*
Group #*
Subscriber Name*
ID #*
Family Doctor*
Doctor's Phone
Date of Last Tetanus Shot
Allergies
Medical Condition(s) to be aware of