STOKED - SURF THERAPYMENTOR REGISTRATION FORM

STOKED - SURF THERAPY

MENTOR REGISTRATION FORM

THANK YOU for your interest in joining the STOKED team, we are so grateful for everyone who puts their hand up to help. It’s so heart-warming to receive these forms back!

STOKED is still a new program, and we are still finding our feet a bit, so let us know if we have missed anything or if you have any questions.

FULL NAME*

DOB*

MOBILE*

EMAIL*

ADDRESS*

Unit/House Number, Street, Town, Postcode

DIETARY REQUIREMENTS*

EMERGENCY CONTACT*

Name, Contact Number and Relationship to Mentor

TSHIRT SIZE*

Select

Bronze Medallion*

Do you hold a Bronze Medallion? Not essential to mentor but handy for us to know!

Select

Working With Children's Check*

Do you have a current Working With Children's Check? (Volunteer level minimum)

Select or enter value

PROGRAM OF INTEREST*

We have programs running at Portland, Warrnambool, and Port Fairy - let us know which one (or all if you're keen) you want to be involved in.

Select

Which sessions of the program can you attend?*

We run each program for six weeks, please let us know which ones work for you to be involved.

Select

NEED A WETSUIT?*

Mentors need to bring their own wetsuits - if you don't have one, let us know your size and we'll lend you one.

PHOTO APPROVAL*

STOKED may take photos and videos to be used for promotion, including media and social media. Please let us know if you consent to your image being used in these forums.

Select

How did you find out about STOKED?*

LIVED EXPERIENCE & YARN CIRCLES

Lived experience and shared storytelling are valuable parts of our program.

Whether it be related to mental health, substance use, hard times, wrong paths, close calls, or epic fails.

These personal stories can be super engaging and inspiring, perfect for getting good messages across to young people.

Do you have some lived experience that you would feel comfortable and passionate about sharing to a group?*