Black Surf Santa Cruz Membership Form

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Thank you so much for your interest in being a part of our community here at Black Surf Santa Cruz! Please complete this form to officially register as a member and gain access to our programming.

Please note - our organization is intended as a safe space for Black, Indigenous, people/communities of color and other historically excluded groups to be in community and learn how to surf. Filling out the additional demographic information at the bottom helps our organization tremendously. Please self-disclose to your own comfort level. We are excited to have you join us!

Our mission is to promote physical, spiritual and communal healing through surf, education, recreation and advocacy. We do this by intentionally centering and celebrating Black, Indigenous and other communities of color. Come learn with us!

Email *

First + Last Name *

Phone *

What's your Zip Code? *

Birthdate *

YYYY

Emergency Contact

Emergency Contact Phone *

Emergency Contact Relationship *

How did you hear about Black Surf Santa Cruz? *

Do you have your own equipment? *

No - I need to borrow both a board and suit

Yes - Good to go!

Yes - Surfboard only/ need to borrow wetsuit

Yes - Wetsuit only/ need to borrow surfboard

Would you be interested in swim lessons? *

Yes

Maybe

Would you be interested in water safety lessons? *

Yes

Maybe

Please note any medical, special and accessibility needs:
*

Allergies

Medications

Physical Limitations

Dietary Restrictions

No allergies, medications, etc.

Other:

Required

Your swimming ability: *

Cannot swim

Can swim across shallow end

Can swim across deep end

Can swim 1 length of pool

Can swim 4 lengths of pool

Can swim 8 lengths of pool

How many times have you surfed in your life? *

Never

Less than 5 times

5-10 times

10-20 times

20-50 times

Over 50 times

Our programs take place at various beach locations throughout Santa Cruz County (including Pleasure Point, Cowells Beach, Manresa, etc.) Do you have access to reliable transportation?

I will meet you at the beach

I have my own transportation

I do not have access to a car and will need transportation assistance

Other:

Demographic data (optional, but highly encouraged):

What is your race? (Select all that apply.)

American Indian or Alaska Native

Asian Indian

Black or African American

Chinese

Filipino

Japanese

Korean

Vietnamese

Other Asian

Native Hawaiian

Guamanian or Chamorro

Samoan

Other Pacific Islander

White

Prefer not to answer

Other:

Are you Hispanic or Latino/a/e/x?

No, not of Hispanic or Latino/a/e/x Origin

Yes, Mexican, Mexican American, Chicano/a

Yes, Puerto Rican

Yes, Cuban

Yes, Central American

Yes, South American

Yes, Another Hispanic or Latino/a/e/x

Prefer not to answer

Other:

Clear selection

Which of the following best describes you? (Select one answer.)

Woman (could include cisgender women, transgender women, and female-identified individuals)

Man (could include cisgender men, transgender men, and male-identified individuals)

Nonbinary

Agender

Gender-fluid

Gender-queer

Prefer not to answer

Other:

Clear selection

Which language(s) do you speak?

Send me a copy of my responses.

Submit

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