Form Builder

First Name

Last Name

Address

City

State / Province / Region

ZIP / Postal Code

Country

Phone

Guest #1

Head of Household. (See Exhibit A for definitions.)

First Name

Guest Last Name

Age

Low Income?

Race/Ethnicity

Disabled?

Title 1 School?

Foster or Transitional Youth?

Guest #2

Guest #2 Information(See Exhibit A for definitions.)

First Name

Last Name

Age

Low Income

Race/Ethnicity

Disabled?

Title 1 School?

Foster or Transitional Youth?

Additional Information Needed

How many in your family/group will be staying at a waterfront resort for the first time?

Please enter a number from 0 to 6.

How did you hear about this program?

Other

I (we) are interested in water sports rentals.

I (we) are experiencing economic hardship

Certification : I hereby certify that I am a California resident and that the above is true and correct as of the date of my signature below, and that I and the other guests in my group are eligible to participate in the Free Stay Program as underserved youth or families. I agree to provide any additional documentation required by Paradise Point Resort or the California Coastal Commission to document my/our household eligibility.

Name for Consent

Date

Name of Parent or Guardian (for any minors):

Date

Thank you.

All participants and their guests must comply with Paradise Point's Rules, Regulations, and Policies, which can be found here. This Free Stay Program is provided in cooperation with the California Coastal Commission and any information provided for the program may be shared with the California Coastal Commission.