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Who is Patrick Ivison
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And Rina too!
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Waves of Empowerment Flyer
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Registration, Releases & Waivers
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Register to participate
If you would like to participate in a Waves of Empowerment session, please register by completing the form below. See you there!
How did you hear about Ricochet, Cori or Waves of Empowerment?
# of adults attending
# of kids attending
Does your child under 18 want to participate?
If yes, what is your child's name?
Are you a veteran or active duty service member?
Do you need a life jacket?
Do you need a wetsuit?
If yes, please complete the boxes below
Would you feel comfortable being interviewed by the media?
What activities are you interested in? Choose all that apply
Canine-assisted surf therapy with Ricochet
Canine-assisted Swimming with Cori
Canine-assisted stand up paddle boarding
Would you like your child matched with a military mentor?
Please note: If a veteran mentor isn't available, a civilian mentor will be assigned.
Do you or your child have a special diet?
Do you or your child have allergies?
Do you or your child have special needs or challenges? Check all that apply
Traumatic brain injury
Other challenges not listed
What is you or your child's mode of communication? Check all that apply
Uses augmentative device
Follows simple directions
Is your child a flight risk?
Does your child have specific toileting needs?
Do you or your child have any fears, dislikes or aggressive behavior? If yes, please describe
Do you or your child use a wheelchair?
Do you need a beach wheelchair?
Will you be bringing a service dog?
Additional information that would help our volunteers make your experience the best it can be.
Understood and agreed to by:
I have read and agreed
Check here to indicate that you have read & agree to the terms of the waivers and releases.
Click here to read the photo release, volunteer waiver, insurance waiver, and release of liability.
Your electronic signature below indicates that you have read the waivers and releases carefully and fully understand their provisions and agree with all of their conditions.
I am 18 years or older
Names of children, other family members or friends you're signing for
The primary location where we surf is La Jolla Shores. Sometimes we surf at Cardiff. Below are maps for both locations.
Surf Dog Ricochet is the only SURFice dog® on the planet who provides canine-assisted surfing, paddling, swimming, playing and therapy to empower
kids with special needs, people with disabilities, wounded warriors & veterans with PTSD... taking them from the battleground to the playground!
Web design, all content, pictures and videos on this website are ©copyrighted and strictly prohibited to be used without prior express written consent
from Puppy Prodi
and Ricochet® are federally registered trademarks of Puppy Prodigies. All rights reserved © 2009 Puppy Prodigies