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Surf Therapy RSVP Questionnaire & Release of Liability
Thank you for participating in our Surf Therapy group. We look forward to working with you. We want to gather some basic information regarding your ocean experience to help understand where you are at internally. Please fill out and submit the survey below. Thanks!
Email address *
First and Last Name *
Your answer
Phone # *
Your answer
Which session are you attending? *
Have you ever surfed before *
No, never
Yes, I surf at least 1 time a week
How comfortable are you in the ocean? *
I am terrified
I am a fish
How would you rate your swimming abilities ? *
I can't swim
I could be in the olympics
Are you capable of preforming basic athletic abilities? *
What is your motivation for attending this session? *
Your answer
Is there any fear, anxiety or worry connected to attending this group for you? *
Your answer
Emergency Contact Name and Phone Number *
Your answer
I declare that I am physically fit to participate in this event. I am aware that this activity may be a test my of my physical abilities. I understand I am at my own risk and release Serene Waters Adventure Therapy, LLC from any and all liability before, during, and after this event. If an emergency situation occurs I give S.W.A.T. LLC full permission to perform 1st aid, contact 911 services, and/or contact my emergency contact if needed. I agree to bring any medically necessary items that I may require for my own health (inhaler/medications, etc.) if applicable. Informed Consent- I understand Serene Waters is a mandated reporter (we must report the following by law; a plan/ Intent to harm ones self or others, & reasonable suspicion of child/ elder/ dependent adult abuse.) *
To reserve a spot in the at cost sessions you must purchase a a non-refundable ticket through eventbrite. Sliding scale/scholarships are available, please indicate below if needed and we can work something out. Parking may be additional and at your cost ($2-15) depending on location and duration. *
Are you willing to participate in an anonymous post-surf therapy survey to help make surf therapy an evidence based practice?
Are you OK with your photo being taken and possibly being used for social media/ marketing purposes?
What To Bring & Group Etiquette It is suggested to bring the following: 1.) A bathing suit to wear under the borrowed wetsuit.If you do not borrow a wetsuit we recommend an old T-shirt or rash guard for sun protection. 2.) A towel, drinking water, snack/lunch, and sun protection. Any medically necessary items for your health if applicable (inhaler/medication/etc). 3.)Please respect the other attendees privacy (who you see there and what you hear there let it stay there) Pictures are ok if the other attendees agree to be in the photos (please just ask them). 4.)Be mindful of the environment... don't litter (if you pack in then pack it out) & be aware of your 2nd hand smoke (if you smoke cigarettes/ vape). 5.)Please place phones on silent or airplane mode during meditation/sharing. Allow yourself plenty of time to park we are in the beach cities during the warmer months. 6.) Don't forget your Good Vibes. We cant wait to see you !!!!!
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