2026 PARTICIPANT SIGN-UP FOR SURF WITH THE BLIND & VISUALLY IMPAIRED

Full Name: *

Age: *

DOB: *

Gender: *

Ethnicity: *

Phone: *

Email: *

Mailing Address: *

City: *

Zip Code: *

Height (for wetsuit sizing): *

Weight (for wetsuit sizing): *

How many 'Surf w/ the Blind & Visually Impaired' camps have you attended? *

Do you know how to swim? *yesnosomewhat

Do you know how to surf? *yesnosomewhat

Please note any special needs (Deafness, high-functioning Autism, triggered by touch, allergic to Neoprene, etc) so our team can be prepared to serve participants to the best of our ability.

Do you have any additional comments? *

Emergency contact name: *

Emergency contact phone number: *

On a scale of 1-10, what is your comfortability in the ocean? *

Including yourself, how many total attendees will you have at our event?*

Would you like a lifejacket? *yesno

Please review our US4K Code of Conduct and 2026 Risk Waiver Info.

Name *

Email *

Phone *

Age *

Gender *

Ethnicity *

Mailing Address *

City *

Zip Code *

How many 'Surf w/ the Blind & Visually Impaired' camps have you attended? *

Please note any special needs (Deafness, high-functioning Autism, triggered by touch, allergic to peanuts, etc) so our team can be prepared to serve attendees to the best of our ability.

Including yourself, how many total attendees will you have at our event? *

Additional Info

Please review our US4K Code of Conduct and 2026 Risk Waiver Info.