First:            required Last:            required Company:    Address:     City:               State:     Zip:   Email:       required Home Ph:  Work Ph:    Cell Ph:     Birth Date:   (mm/dd/yyyy) Occupation:    
What is your background: Please Select One Asian/Pacific Islander Native American African American White (Caucasian) Latino/Latina Other

What foreign language(s) do you speak?:


Are there any circumstances that might interfere with you making this commitment?:
Are you interested in our Surfing Program?:       (If yes, please check)
       Have you ever instructed surfing before?:   (If yes, please check)
       How many years have you been surfing?:   
Are you interested in our Snowboarding Program?:       (If yes, please check)
       Have you ever instructed snowboarding before?:   (If yes, please check)
       How many years have you been snowboarding?:   
Are you interested in our Skateboarding Program?:       (If yes, please check)
       Have you ever instructed skateboarding before?:   (If yes, please check)
       How many years have you been skateboarding?:   

Do you have CPR certification?:                   (Please check if you are certified)

People who surf, skate, and snowboard are drawn to this program but, people not active in these sports are also eager to participate. What do you hope to get out of your participation in Boarding House Mentors?:

We are currently enrolling volunteers for the following SURFING events:
(Please check your preference)

                  2008
      June 29                  July 13              
      July 27                   August 10          
      August 17              August 24          
      September  7        September 14    
      September 21       October 5           
      October 19 (SM)   October 19 (Encinitas)