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Wrightsville Beach, NC - Military Day 2022

1 Start 2 Waiver 3 Confirm 4 Complete

Parent Information

First Name *

Last Name *

Suffix

Street Address *

Street Address Line 2

City *

State *

Postal Code *

Country *

Phone Number *

Email *

Service Branch *

Total number of family members attending *

Participant Information

First Name *

Last Name *

Suffix

Birth Date *

Month

Day

Year

Gender *

T-Shirt Size *

Participated in a Surfers Healing event before? *

Yes

Registering Additional Family Members with Autism?

If you wish to register additional campers (up to 3) please specify the required number and proceed. Please do not register family members that are not on the Autism spectrum below, please include them in the "Total number of family members attending" field above.

Number of Additional Campers

2nd Participant Information

Participant is on the autism spectrum? *

Yes

Sorry, you may only register additional participants who are on the autism spectrum.

First Name *

Last Name *

Suffix

Birth Date *

Month

Day

Year

Gender *

T-Shirt Size *

Participated in a Surfers Healing event before? *

Yes

3rd Participant Information

Participant is on the autism spectrum? *

Yes

Sorry, you may only register additional participants who are on the autism spectrum.

First Name *

Last Name *

Name Suffix

Birth Date *

Month

Day

Year

Gender *

T-Shirt Size *

Participated in a Surfers Healing event before? *

Yes

4th Participant Information

Participant is on the autism spectrum? *

Yes

Sorry, you may only register additional participants who are on the autism spectrum.

First Name *

Last Name *

Suffix

Birth Date *

Month

Day

Year

Gender *

T-Shirt Size *

Participated in a Surfers Healing event before? *

Yes

Contact Us

Surfer’s Healing Foundation, Inc.
30767 Gateway Place PMB #126
Rancho Mission Viejo, California
92694

Phone: (877) 966-SURF
Fax: (949) 728-1200