[Secure Form] Surfing For Smiles 2024 (SDOS)

First Name

Last Name

Age

Are you under 18 years of age?

Parent/Guardian First Name

Parent/Guardian Last Name

Phone Number

Home City

Home State

How did you hear about the Surfing For Smiles program?

Other

Please upload your video. This should be the original content of the person or family of the person submitting. (we recommend videos of no longer than 90 seconds, however the maximum file upload size is 250 MB)

Click Here to Upload

Please provide a caption to the video that includes where the video was taken and provides any additional information that you would like to be seen during the public viewing period. This can include information about you, anything or anyone in the video, or other information that you would like shown with your video if you become a semi-finalist during our viewing period. (Please limit response to no more than 300 characters, approximately 50-60 words.)