Day on the Beach Registration Form Name(Required) First Last Email(Required) Enter Email Confirm Email Phone(Required)Date of Birth(Required) MM slash DD slash YYYY Address(Required) Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Name of person filling out this formWho is filling out this form?(Required) I am filling out the form for myself Other Name(Required) First Last What is your relationship to the participant?(Required)Primary disability of participant(Required)If additional disabilities are involved, please describe here:How will you participate?Would you like to participate in an ocean activity or are you coming only for the beach party?(Required)Ocean activities include kayak, outrigger canoe, SCUBA, or beach chair rides. Ocean Activity - ADD ME TO THE WAIT LIST FOR THIS EVENT. Beach Party Only Please note that filling out this form does NOT guarantee your confirmation of ocean activity.We are now placing people on a "waiting list" for ocean activities. Please understand that spaces are limited and we do not want to overbook for your safety. You can still come down to the beach, check in at registration and see if space is available! There are many more activities to do at Day on the Beach, including live entertainment, activities at the Monterey Exploration Center, beach games, fishing on the wharf, and food! Assistance Needed?What assistive devices will be required?wheelchair, walker, cane, etc.HeightWe use this information for wetsuit sizing Weightwe use this information for wetsuit sizing Will assistance be required changing into a wet suit and/or transferring into a boat? YES NO Please describe the level of assistance will be required to enable best support.Activities Please note that filling out this form does NOT guarantee your confirmation of ocean activity. We will try to place everyone into their first or second choice ocean activity. Please understand that spaces are limited and we do not want to overbook for your safety. If you do not receive confirmation of ocean activity for a specific time, you will be placed on a waiting list for ocean sports and we will try to accommodate you at the event. There are many more activities to do at Day on the Beach, including live entertainment, games, fishing on the wharf, and food! Participants will be supported by experienced volunteers in all ocean activities.First Choice of Ocean Activity(Required) Kayak Outrigger Canoe SCUBA Floatation (having the experience to immerse in the ocean, using a beach wheelchair if needed) Beach Wheelchair Rides Second Choice of Ocean Activity(Required) Kayak Outrigger Canoe SCUBA Floatation (having the experience to immerse in the ocean, using a beach wheelchair if needed) Beach Wheelchair Rides Please select the times you are available:(Required)Can select more than one time option. 10:00am 11:00am 12:00pm 1:00pm 2:00pm 3:00pm Describe swimming ability of person participating?(Required) Strong Moderate Leisurely Does not swim Other Are there any current medical situations that we should be aware of?Emergency ContactName(Required) First Last Phone(Required)Closing QuestionsAre you interested in trying fishing on the wharf at Day on the Beach?(Required)This is a Volunteer led fishing experience, a short walk from Cowell’s Beach on the Santa Cruz Wharf. YES, Interested NO Will guests be accompanying participate?(Required) No Yes How many guests?(Required)Interested in Riding the Roaring Camp Train?(Required)Are you interested in transportation to Day on the Beach via the Roaring Camp Train from Felton, CA? The train will take you from Felton to the Santa Cruz Beach Boardwalk, ½ mile from Cowell’s Beach, and will return you back to Roaring Camp at the end of the day. Avoid the beach traffic and add a fun train ride to your day! The beach train ride cost is $31.00 per adult, and $25.00 per child. YES NO How did you hear about Day on the Beach? Attended Day on the Beach before Attended other Shared Adventures activities From a friend Saw flier/ad Shared Adventures website Referred by case manager/organization Other Any questions or comments about Day on the beach?Please explainCommentsThis field is for validation purposes and should be left unchanged.
