Please notice: You can ignore irrelevant fields. Positions marked with * are obligatory.These fields must be filled out that the form can be submitted.

Name, surname of the participant:* ---Mrs.Mr.

Name, surname of the applicant:* ---Mrs.Mr.

Additional people accompanying:

Street:* No.:* Stair: Apt.:

Loc.:* ZIP:* Country:*

Tel.No:*
(f.Ex..: 0044 660 123456)

E-Mail:*

Date of birth of participant:* ---JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember ---01020304050607080910111213141516171819202122232425262728293031 ---20142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920

Weight:* Size:*

Date of swimming:*---JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember ---01020304050607080910111213141516171819202122232425262728293031 ---201320142015201620172018201920202021202220232024202520262027202820292030 Duration of stay: 010203040506070809101112131415 days

Location:* ---AntalyaConstanta

What is your objective at the swim? e.g. educational, theme holiday, family experience, personal growth...

Additional Information or an illness:

Epilepsy*  Yes No

Your travel information if available:

Hotel

Flights (arrival / departure )

What would be the ideal swimming time for you?

You participated in one of our programs before?*:  yes no

If yes: Do you prefer one of our instructors?

How did you hear about our program?

Upgrades:

 I want to book the DOLPHINSWIM holiday apartment (300.- EUR per weeks)
 I want to book a cancellation insurance (EUR 227.-)

Agreements:

 I agree that my dolphin swim will be photographed and recorded on Video (participants recieve a DVD of their therapy on the last day of therapy)
 I agree that my therapy photos will be published on the dolphinswim AlphaTherapie facebook site

Guidelines and Information download here

I have read the guidelines and accept

Terms of Business download here

I have read the terms of business and accept

Note: After you have completed this online registration DOLPHINSWIM Institute will send you the registration confirmation and invoice. The registration is completed with the payment of the initial payment of 20% which must be taken within 1 week. The final payment is due 3 weeks prior to the date of swimming. We will inform you by email on the exact swimming time 3 days upon arrival at the dolphin center.

Digital signature: Please type the letters in the field below. Consider the use of capital letters: