Participant First Name Last Name Phone Number Email Address Address Address Address 2 City/Town State/Province - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code Age Shirt Size - Select -Extra SmallSmallMediumLargeExtra Large Height Height and weight will be used to select correct gear sizing for the participant. Weight Height and weight will be used to select correct gear sizing for the participant. How has cancer affected your life? How did you learn about the Survivor Summit Surf Camp? Snacks and lunch may be provided. Do you have any food preferences or allergies we need to know about? Do you have any special physical or mental needs we need to be aware of, or anything important that will help us prepare to give you the best surf lesson possible? Learning to surf is a physical activity involving elevated heart rate while listening to instruction from our staff. It is very similar to learning how to swim or ride a bike. Are you physically healthy enough to learn how to surf?
