August 29th Streets of Hope Participants Signup

Surf Session: AM Session (9:00AM Arrival)

Caregiver First & Last Name: *

Caregiver Contact Phone Number: *

Caregiver E-mail Address: *

Caregiver/youth Address: *

Caregiver relationship to the child: *

Are you the legal guardian of this child? *yesno

Youth (Athlete) First & Last Name: *

DOB: *

Age: *

Gender: MaleFemaleTransgenderNonbinaryOther (please specify)

Other:

Gender pronouns (ex: She/Her, He/Him, They/Them)

Ethnicity (Choose one): *Native/American IndianAsian/ Asian AmericanBlack/African AmericanNative Hawaiian/Pacific IslanderCaucasian/WhiteLatinx/HispanicMulti-Racial (2+ races/ethnicities)Additional/Other ethnicity (please specify)

Other Ethnicity:

Is this your first time visiting the ocean?*yesno

Is this your first time participating with Urban Surf 4 Kids?*yesno

If no, how many times have you visited a US4K camp?

Do you grant Urban Surf 4 Kids permission to take photos and/or videos of your child for private, public, or media purposes? *yesno

Session: AM Session (9:00AM Arrival)

Caregiver First & Last Name: *

Caregiver Contact Phone Number: *

Caregiver E-mail Address: *

Caregiver/youth Address: *

Caregiver relationship to the child: *

Are you the legal guardian of this child? *yesno

Youth (Athlete) First & Last Name: *

DOB: *

Age: *

Gender: MaleFemaleTransgenderNonbinaryOther (please specify)

Other:

Gender pronouns (ex: She/Her, He/Him, They/Them)

Ethnicity (Choose one): *Native/American IndianAsian/ Asian AmericanBlack/African AmericanNative Hawaiian/Pacific IslanderCaucasian/WhiteLatinx/HispanicMulti-Racial (2+ races/ethnicities)Additional/Other ethnicity (please specify)

Other Ethnicity:

Is this your first time visiting the ocean?*yesno

Is this your first time participating with Urban Surf 4 Kids?*yesno

If no, how many times have you visited a US4K camp?

Do you grant Urban Surf 4 Kids permission to take photos and/or videos of your child for private, public, or media purposes? *yesno