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Date of birth:
—Please choose an option—PoorAverageGoodExcellent
Can you swim 200m unassisted?
Do you experience sea sickness?
—Please choose an option—Very rarelySometimesAlwaysUnsure
Dietary requirements & other notes:
© 2023 Jono Allen.
DateWeek 1Week 2Week 3
Level of swimming abilityPoorMediumGoodExcellent
If you have any dietary restrictions please let us know. Currently we can accommodate most restrictions such as: vegetarian, vegan, gluten-free, lactose free, intolerances and allergies.
I am in good health, physically fit, can swim at least 200 meters unaided, and do not have any health or physical impairments or conditions, including but not limited to back and neck problems, history of heart conditions and/or seizures, or mental impairments such as anxiety or phobias that would or should prevent me from participating in the program.
I understand that there are inherent risks involved in water and animal activities, including but not limited to swimming, being in deep water, being near, interacting with whales or other land or marine animals, and that I could suffer scrapes, bites, cuts or bruises, and/or more serious injuries or illnesses. I agree to assume all risks, known and unknown, of serious personal injuries ,death, illnesses and/or loss of personal property resulting from or in any way connected with attendance at or participation in the Program
I am at least 18 years of age and am of sound mind. I have read and understand the foregoing release and accept and agree to its terms and sign it voluntarily.
If you have any questions or additional info you would like to provide please email us at email@example.com
If you are over the age of 55, you may be required to provide physical from your medical provider. Please contact for more information. Please list any medical conditions or pre-existing concerns.