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HACORP Intake

HACORP Initial Interest Application

Hero Adaptive Combat, Ocean & Recovery Program

This initial form helps us understand your background, travel readiness, prior experience, and any general accommodations that may help create a safe and positive experience.

This is not a medical evaluation and does not guarantee program acceptance. Please do not submit detailed medical records, military records, diagnosis documents, or other sensitive documents through this form. If additional screening is needed, it may be handled separately by an authorized veteran support or clinical partner.

Website

Personal Information

Full Legal Name *

Preferred Name / Nickname

Date of Birth

Email *

Phone *

Emergency Contact

Home Address

Military Service Background

Branch of Service

Years of Service

Current Status

Currently connected with VA services?

Program Interest & Experience

What interests you most about HACORP?

Brazilian Jiu Jitsu Surfing Yoga / Mobility Ocean & Nature Activities Veteran Community Mental Wellness & Recovery Physical Fitness Adventure & Travel

Have you trained Brazilian Jiu Jitsu before?

Have you surfed before?

Physical Activity & Accommodations

Do you have any physical limitations, injuries, or disabilities that may require activity modifications?

Able to travel internationally and participate in light-to-moderate physical activity?

Do you currently have a valid passport?

Closest Major Airport

Would you require financial assistance or sponsorship?

Final Questions

How did you hear about HACORP?

Anything else you would like us to know?

Acknowledgement & Consent

I understand this is an initial interest application only and does not guarantee program acceptance. I understand this form is not a medical evaluation and I should not submit detailed medical records, military records, diagnosis documents, or other sensitive documents through this form. I consent to being contacted by Hero Academy / HACORP regarding participation opportunities and potential next steps.