Oregon Independent Living Program 2017 Surfing Adventures ADULT Registration
The Department of Human Services-ILP, Alchemy Consultation & Training Services, and Oregon Surf Adventures has teamed up and APPROVED 75 youth in foster care to attend an experiential learning activity involving surf lessons!
Session Dates: Session 1: Friday, June 30, at 1 p.m. (August 8th was not available – sorry!) Session 2: Friday, July 28, at 1 p.m. Session 3: Wednesday, August 2, at 1 p.m.
Length of Activity: 4 ½ to 5 hours depending on how long it takes to outfit the group. Youth and staff will be outfitted by Oregon Surf Adventures then drive to the beach. Park your car and begin your hike with rented boards, wetsuits, booties and gloves Receive dryland instruction, safety and risk awareness orientation by instructors and owner, and supervised surf time.
Mandated Staffing: Adults - a MINIMUM of 1 staff to every 5 youth is needed for supervision. Staffing is mandatory and the clients you come with are your responsibility directly before and directly after their activity. Staff can enjoy beach time and we invite you to jump in for some fun to support your clients during this life changing experience.
HOW EXPERIENTIAL WORK CAN CREATE TRANSFEREABLE EXPERIENCES: Step 2: Ground Yourself in Awareness of Place Step 3: Internal Landscape makes a shift Step 4: Nature/Experiential Playground serves as a great healer & emotional recycler
Last year the take always were that our youth felt SUPER empowered. Their confidence was pouring out of our photos of the ways they held themselves. They loved the experience and stated repeatedly "I had no idea I could do that!" They went from scared to proud in under an hour. Youth will get experience with water safety, they'll get to borrow expensive gear that is more than adequate for their environment, and they go on a short but beautiful day hike down to the water. This will be an experience your teens will not soon forget. This will prove to be an excellent rapport building opportunity for you and your youth.
Safety: Oregon Surf Adventures will have approximately four to seven staff who are all life guard certified. Youth will be wearing wetsuits that will keep them buoyant and warm. DHS, Tribal and ILP Staff (or other volunteers) must equal 1 adult for every 5 youth. We successfully conducted this activity last year with no issues or incidents.
PLEASE DIRECT ALL REGISTRATION QUESTIONS TO:
Rosemary Iavenditti, 503-945-5688 Email: [email protected] Oregon Independent Living Program
Limitations – please2017 list any Surfing limitations in activitiesAdventures or duties we ADULT Registration may assign to you:
Will you be providing transportation for youth? Yes No Vehicle make/model: # of passengers:
Auto Insurance: Policy #:
I have attached a copy of the signed release forms.
Adult Signature Date
Please indicate which Session you would like to apply for: Session 1: June 30, 2017, Friday Session 3: August 2, 2017, Wednesday Session 2: July 28, 2017, Friday Fax registration form to (503) 945-6969 or Scan and Email registration forms to: ILP.Central @state.or.us
Name Gender Preference male female Address non-English Speaker Language:
City, St, Zip Phone Email Age/DOB Ethnicity Tribe
Agency/Organization
IL Provider Caseworker Foster Parent Volunteer Other: Background check on file with:
Background check never performed (required prior to attending Conference)
Emergency Contact: Phone Doctor Phone
Special Medical Needs Allergy Heart Diabetes Insect bites Drug reaction Epilepsy Pregnant Handicap Other: (Please describe special needs on a separate sheet of paper and submit with this application)