Black Surf Santa Cruz Membership Form
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 *
Which region/state/county/neighborhood/zip code do you live in? *
Birthdate  *
Emergency Contact

Emergency Contact Phone *
Emergency Contact Relationship *
How did you hear about Black Surf Santa Cruz? *
Do you have your own equipment? *
Would you be interested in swim lessons? *
Would you be interested in water safety lessons? *
Please note any medical, special and accessibility needs:
Your swimming ability: *
How many times have you surfed in your life? *
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?
Demographic data (optional, but highly encouraged):
What is your race? (Select all that apply.)
Are you Hispanic or Latino/a/e/x?
Clear selection
Which of the following best describes you? (Select one answer.)
Clear selection
Which language(s) do you speak?
Clear form
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