Adventure Centers Hawaii

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To ensure that we can provide an inclusive and enriching experience for everyone, we kindly request your assistance in completing the qualifications questions below. Your responses will play a pivotal role in customizing our program to meet the diverse needs and aspirations of our community.
This form has been thoughtfully designed to prioritize inclusivity and ensure that individuals with fewer means have equal access to this exciting activity.

Email *

Participant Questionnaire: Bridging Barriers Through Bouldering Program

Full Name - If Family, Family Name *

If more than one person in this application, please list all persons who are a part of this application

Age (or Ages) *

Email & / or Phone, or how can we get ahold of you

Address if you have one

Select at least one of the following options to indicate your eligibility:

We/I have an annual income below what allows us to afford this activity.

We/I are/am eligible for government assistance programs like SNAP or Medicaid.

I am a veteran or in the armed services / I am the child or spouse of a veteran.

We participate/are in the foster care system.

We/I am experiencing homelessness or live in a shelter or transitional housing.

We/I reside in a neighborhood or community with a documented low socio-economic status.

I am a first-generation college student (the first in my family to attend college).

I am a person with physical or cognitive disabilities who may require extra support and resources to participate in bouldering.

We/I are/am from diverse cultural backgrounds and have limited English proficiency and often face additional hurdles in accessing opportunities.

We/I are/am from a single-parent with limited resources.

This person/family was recommended by a community organization as a qualified individual. The community organization is:

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