Surf For The Soul 2009 Volunteer Registration

REGISTRATION FORM May 3rd, 2009 Circle One:

Youth Surfer

Youth/non-surfer

Volunteer

Name________________________________________________ (Please circle one)

Parent/Caregiver M

F

Age ____ Birth date ____/____/____ T-shirt size _____ (Y) (A) Grade completed ____________ Check One Parent/Caregiver Name ___________________________________Ethnicity/Race ______________ Mailing Address___________________________________________________________________ City ________________________________________________ Zip Code____________________ Day Phone_________________ Evening Phone __________________Cell phone_________________ Emergency Contact____________________________________ Phone_______________________ Doctor’s Name______________________________________ Phone ________________________ Email Address ___________________________________________________________________ Swimming Skill Level: Strong ____ Good ____ Beginner _____ (Check one) Volunteer surfer (Check): AM sessions only___, PM sessions only___, All day_____ *Parent/s or an adult must accompany children and youth* I/WE, _____________________________________, HERE BY AUTHORIZE THE STAFF OF KIDS HURT TOO TO ACT ACCORDING TO THEIR BEST JUDGEMENT IN ANY EMERGENCY REQUIRING MEDICAL ATTENTION AND I HEREBY WAIVE AND RELEASE KIDS HURT TOO AND IT’S AFFILIATES FROM ANY AND ALL LIABILITY FOR ANY INJURIES OR ILLNESSES INCURRED WHILE AT THE SURF FOR THE SOUL EVENT. I HAVE NO KNOWLEDGE OF ANY PHYSICAL IMPAIRMENT THAT WOULD BE AFFECTED BY THE ABOVE NAMED PARTICIPANT IN THE SURF EVENT. I ALSO UNDERSTAND THAT KIDS HURT TOO RETAINS THE RIGHT TO USE FOR EDUCATIONAL PUBLICITY AND ADVERTISING PURPOSES PHOTO-GRAPHS AND VIDEO TAKEN AT THE SURF FOR THE SOUL EVENT. PARENT/GUARDIAN SIGNATURE________________________________ DATE ____________________ FOR OFFICE USE ONLY: DATE RECEIVED_________________________________ DATE CONFIRMED ________________________

Waikiki Beach

SURF FOR THE SOUL KIDS HURT TOO is excited to announce the third annual Surf for the Soul event to take place on May 3rd at Kuhio Beach. This program will provide children and youths the skills and resources for coping with loss through the experience of surfing and ocean wisdom. It will be video taped. There will be fun, food, games and prizes. Please join us for this great event.

WHEN: May 3rd at 8:30 am to 3 pm WHERE: Kuhio Beach by the banyan tree; Parking at the Zoo metered lot or Kapiolani Park; then walk up Kalakaua Ave. to the banyan tree. SURF FOR THE SOUL AGENDA Children going in the water should wear water shoes and swim wear; bring a towel, sunscreen, change of clothes 8:00 A.M. Families arrive, breakfast snacks 8:30 to 9:00 9:00 to 10:00 10:00 to 11:00 11:00 to 12:00 12:00 to 1:00 1:00to 200

Chant, Blessing, Executive Director’s Welcome Sharing Story for Surf for the Soul Rules and expectations 1st Session of Surf Instructions for the registrants 2nd Session of Surf Instructions for the registrants lunch Juice and water provided; Craft Activities 3rd & 4th Surfing Lessons, Games, and Crafts

2:30 Gifts for Surfers 3:00 Pau. Thank you for coming.

If you are interested, please contact and/or complete the attached form and fax or mail it to: Kids hurt too P.O. Box 11260 Honolulu, HI 96828 Phone: 545-5683 and Fax: 735-2989 This program is provided free of charge. Donations are accepted to support Kids hurt too services.