Alpha-Therapy reservation form

Before you fill out this form, please contact us upon the availability of your desired date. Please notice: Positions marked with * are obligatory. These fields must be filled out, that the form can be submitted. All other irrelevant fields you can ignore.

    Name, surname of the participant (child):*

    Name, surname of the applicant (parents):*

    Additional people accompanying (names, date of birth):

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

    City.:* ZIP:* Country:*

    (f.Ex..: 0044 660 123456)


    Date of Therapy:* Number of therapydays: days

    Location of the therapy:*

    Participants personal data:

    Date of birth:*

    Weight:* Size:*

    Description of the participant's difficulties or diagnose if available:*





    Previous and current therapies:

    Your travel data if available:

    Hotel: Flights (arrival / departure ):

    Your prefered therapy time:

    You participated in one of our programs before?*

    Do you prefer one of our therapists?

    How did you hear about our program?


    Booking vacation apartment
    Booking free cancellation upgrade for the therapy (EUR 227.-)


    I agree that my dolphin therapy 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 with the payment details. 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 6 weeks prior to therapy. We will inform you by email on the exact therapy time 3 days upon arrival at the therapy.

    Digital signature: Please type the letters presented in the left field below into the field next to it on the right. Consider the use of capital letters:


    Hotlines: Deutschland: +49 2443 9629844 Österreich: +43 676 3063857 Schweiz: +41 44 585 17 25 United Kingdom: +44 203 286 4605 Россия:+7908 292 28 27 Ireland: +353 87 4615850 Danmark: +45 51350033