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Your information

First Name Last Name

Email Phone Cell

Address City State

Zip Country

Age Height Weight Birthday Shoe Size Shirt Size

May we sign you up for our monthly newsletter?

Emergency information

Insurance Co Policy No Insurance Phone

Doctor Emergency Contact Name and Phone

Should a serious injury or accident occur and we are unable to contact the emergency person and/or physician, permission is hereby granted for medical care to be given as required. The undersigned person is responsible for any fee involved.

Name Date

Please describe any medical conditions or restrictions that we should be aware of? This includes allergies, medications, past injuries, hearing or vision, etc.:

Tell us about yourself

Please list any foods that you do not eat. Please note, special or extreme diets that require individual meal preparation will incur an additional charge.

What foods do you most enjoy eating?

How did you find us? If other, please describe

Please rate your skill/comfort level (0 = Never Have; 10 = Professional Level)

Swimming  0 1 2 3 4 5 6 7 8 9 10

Surfing  0 1 2 3 4 5 6 7 8 9 10

Yoga  0 0 1 2 3 4 5 6 7 8 9 10

Will you be bringing your own surfboard? If so, what size is it?

Your vacation details

Surf and Yoga Dates that you will be attending?

Guestroom Choice:

Do you have a person to share with? If so, what is their name?

Pay in full 90 days prior to the retreat start date and receive a $100 Aloha Discount. Does the $100.00 Aloha Discount* apply to you? yes no

*please, no extensions for the Aloha Discount.

Flight information

Date and time of your arrival Airline/Flight Number

Date and time of your departure Airline/Flight Number

Please note, if you do not have your flight information at time of booking, please email it to us when you have booked your flight.

Refer a Swell Person

Name E-Mail Address

ALL SWELLWOMEN AND SWELLCO-ED SURF AND YOGA RETREATS ARE SMOKE-FREE, DRUG-FREE AND ALCOHOL-FREE EVENTS*

*If you are feeling festive, there are bars and restaurants in the nearby vicinity that you may go to for cocktails. A glass of wine or a beer with dinner is permitted.


 I have read and understand the Booking, Travel Flight and Cancellation Policies
 I agree to all SwellWomen and SwellCo-ed terms and conditions
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