Surf Therapy Program Application

Limited Places Available

I understand this is an application and not a confimed booking. If accepted, I will receive payment instructions and onboarding documentation.

First Name *

Last Name *

Phone *

Email *

Preferred Surf Therapy Program Start Date:

What are you hoping to gain from this Surf Therapy program? *

Do you have any injuries or medical considerations I should be aware of? *

I acknowledge and agree to receive emails about upcoming programs, retreats, and wellbeing resources. I understand I can unsubscribe at any time.

I have acknowledged and agree to the Mindswell Therapy Privacy Policy and Mindswell Therapy Terms of Service. I understand this program involves participation in outdoor and water-based activities in public settings and that further consent, risk acknowledgement and medical documentation may be required prior to participation.