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Name*
FirstLast
Email*
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Cell
Address*
Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry
Age*
Date of Birth*
Height*
Weight*
Shirt Size*
Shoe Size*
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How did you find us?*
Name of friend, magazine or other referral?
Can you help us thank the source of your refferal?
Emergency Info
Insurance Co*
Policy No*
Insurance Phone
Doctor
Emergency Contact Name and Number*
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 non-food allergies, medications, past injuries, hearing or vision, etc.

Tell us about yourself
What foods do you most enjoy eating?
Please list any foods that you do not eat.
Please list any foods that you are allergic to and tell us how severe your allergies are to each listed food.*
*Please note, special diets, food allergies or food restrictions that require individual meal preparation will incur an additional charge.
Please rate your skill/comfort level (1 = Never Have; 10 = Professional Level)
Swimming*
Surfing*
Yoga*
Your vacation details
Surf and Yoga Dates that you will be attending?*
Guestroom Choice*
Name of the person you will be sharing with
Does the $100.00 Aloha Discount* apply to you?*
- Yes
- No
*Pay in full 90 days prior to the retreat start date and receive a $100 Aloha Discount, sorry no extensions for this discount.

Travel Information
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.
Arrival Date
Arrival Time
: HH
MM
Airline & Flight Number
Departure Date
Departure Time
: HH
MM
Airline & Flight Number
Refer a Swell Person
Name
Email
Policy
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.
BOOKING POLICY: Booking is based on a first come, first serve basis and is limited to 12-15 guests per retreat. It is advisable to make your reservations as early as possible to secure your space. Prices do not include airfare and airport transfer. Please be advised to confirm availability prior to purchasing your airline ticket. All dates are travel dates. The first date is your arrival day and the last date is your departure date. MasterCard, Visa, checks, and money orders are accepted. Please make checks payable to: SwellWomen and mail them to SwellWomen PO Box 1294 Puunene, HI 96784. $500 reserves your space. The remaining amount is due 30 days prior to arrival or you may pay in full 90 days in advance to receive your early registration Aloha discount. Please refer to our cancellation policy for any changes or cancellations. Guest’s roommates are not permitted. After payment has been received you will receive a confirmation by e-mail and will be sent additional information such as a suggested packing list and shuttle service information prior to your departure. TRAVEL AND FLIGHT POLICIES: Please book your flights to and from the Kahului Airport (OGG) in Maui to arrive on the first posted retreat date and to depart on the last posted retreat date. It’s recommended to book your flight into Kahului Airport (OGG Code) to arrive between the hours of noon-3:00pm and to depart after 2:00pm. Resort Check-in is at 3:00pm and Check-out is at noon. Airport transfer is not included in your rates. Speedi Shuttle at (808) 242.7777 provides transfers from the Kahului Airport (OGG Code) to our resort accommodations for approximately $54.00 per person (one way). The return is approximately $47.00. If you are traveling with a group or another individual the rates are discounted. Upon completed registration with us, additional shuttle service information will be provided to you. CANCELLATION POLICY: Below are the guidelines if you must cancel your surf and yoga wellness retreat: We do offer cash or credit card refunds. If you must cancel your reservation, your cancellation fee will be determined accordingly: If you cancel your reservation 30 days or more prior to the retreat start date, you will be charged a cancellation fee of $500.00. If you cancel your reservation 15-29 days prior to the retreat start date, you will be charged a cancellation fee of 50% of all payments received including your deposit. If you cancel your reservation within 0-14 days of the start date, you will forfeit 100% of all payments received including your deposit. All remaining balances will be refunded back to your credit card. Exceptions to our policy cannot be made for any reason, including weather, hospitalization, business emergencies, personal/family emergencies or personal/family illnesses. There are no discounts for arriving late or leaving the retreat early. SwellWomen highly recommends purchasing Travel Protection Insurance through your travel agent. Travel protection insurance is used for any unexpected additional travel expenses that may occur before, during or after your trip. If SwellWomen must cancel a retreat, all payments received to date will be refunded, which constitutes full settlement. SwellWomen is not responsible for expenses incurred in preparation for any canceled trips, such as airline tickets, or for costs incurred due to travel delays, flight cancellation or illness, etc... Guests who fail to provide personal information and signed Release of Liability and Assumption of All Risks and Media Release in your reservation from prior to their departure will not be allowed to participate in the retreat. Furthermore, the above cancellation policy will apply. PARTICIPANT AGREEMENT, RELEASE AND ASSUMPTION OF RISK: In consideration of the services of SwellWomen, their agents, owners, officers, volunteers, participants, employees, and all other persons or entities acting in any capacity on their behalf hereinafter collectively referred to as SW, I hereby agree to release, indemnify, and discharge SW, on behalf of myself, my children, my parents, my heirs, assigns, personal representative and estate as follows: I acknowledge that my participation in surfing entails known and unanticipated risks that could result in physical or emotional injury, paralysis, death, or damage to myself, to property, or to third parties. I understand that such risks simply cannot be eliminated without jeopardizing the essential qualities of the activity. The risks include, among other things: Being hit by the board, other surfers or their boards which could result in cuts, bruises, or abrasions, and concussions; hitting the bottom of the ocean; sprains, strains, broken bones, paralysis, even death; exhaustion, dehydration, sunburn; exposure to poisonous and/or carnivorous sea creatures; and accidental drowning. Furthermore, SW employees have difficult jobs to perform. They seek safety, but they are not infallible. They might be unaware of a participant's fitness or abilities. They might misjudge the weather, the elements, or the terrain. They may give inadequate warnings or instructions, and the equipment being used might malfunction. 2. I expressly agree and promise to accept and assume all of the risks existing in this activity. My participation in this activity is purely voluntary, and I elect to participate in spite of the risks. 3. I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless SW from any and all claims, demands, or causes of action, which are in any way connected with my participation in this activity or my use of SW\'s equipment or facilities, including any such claims which allege negligent acts or omissions of SW. 4. Should SW or anyone acting on their behalf, be required to incur attorney's fees and costs to enforce this agreement, I agree to indemnify and hold them harmless for all such fees and costs. 5. I certify that I have adequate insurance to cover any injury or damage I may cause or suffer while participating, or else I agree to bear the costs of such injury or damage myself. I further certify that I am willing to assume the risk of any medical or physical condition I may have. 6. In the event that I file a lawsuit against SW, I agree to do so solely in the state of Hawaii, and I further agree that the substantive law of that state shall apply in that action without regard to the conflict of law rules of that state. I agree that if any portion of this agreement is found to be void or unenforceable, the remaining portions shall remain in full force and effect. By providing a signature in this reservation form, I acknowledge that if anyone is hurt or property is damaged during my participation in this activity, I may be found by a court of law to have waived my right to maintain a lawsuit against SW on the basis of any claim from which I have released them herein. By providing a signature in this reservation form, the participant, states that he/she: 1 has informed SW, in writing, of any existing conditions that may be affected due to the nature of the program, 2 is aware of and understands the potential hazards and risks, and 3 chooses to voluntarily participate. I have had sufficient opportunity to read this entire document. I have read and understood it, and I agree to be bound by its terms. RELEASE OF LIABILITY:The undersigned assumes all responsibility for and all risk of damage, injury, or loss of property that may occur to the undersigned as a participant in the SwellWomen SW Experience while using facilities, equipment and as a participant in all SW activities, included but not limited to; surfing, stand-up paddling, yoga, hiking, swimming, snorkeling, etc… The undersigned hereby releases and discharges SwellWomen, its faculty, staff, administrators, trustees, and employees from all claims, demands, rights of causes of action, present and future, whether known or unknown, and resulting from the undersigned's participation in the above stated program. MEDIA RELEASE FORM:I acknowledge that I may be photographed or video taped and displayed in any form or manner, including but not limited to; books, displays, publications, newspapers, advertisements, website, press releases, articles, promotions, promotional video, etc…This footage may also be released to SwellWomen affiliates Maui Surfer Girls, sponsors, etc… and displayed in any form or manner, including but not limited to; books, displays, publications, newspapers, advertisements, website, press releases, articles, promotions, promotional video, etc… Your signature on your reservation form below releases all liability from SwellWomen, including staff members and SwellWomen Experience directors.
I have read and agreed to SwellWomen's Booking, Travel Flight and Cancellation Policies*
- Yes
I have read and agreed to SwellWomen's Terms & Conditions and Release of Liability*
- Yes
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