Wailana Malie Massage Clinic MAE 2105

52-4670 Government Rd.,Kapa'au,HI 96755 (808)854-9283

Email:lomihawaii@lomihawaii.com

Date of Retreat attending__________________
Name_____________________________________________________
first middle last (as it to appear on certificate.)
Date of birth_________________
mailing address___________________________________________
___________________________________________Email:_____________________
telephone numbers- home___________________ soc.sec. #_____________
in case of emergency, notify____________________________________
please list any medical problems, major operations, injuries, etc: _______________________________________________
are you under the care of a physician, psychiatrist, or any other type of treatment? Yes/no
if so please indicate: _____________________________________
please list any medications: ______________________________
have you had any previous experience with bodywork? Yes/no
what types?______________________________________________

Are you a licensed therapist? Give us your License or Massage permit number________________________________________
please tell us why you want to study Hawaiian lomi lomi massage______________________________________________________

_____________________________________________________________
deposit of $200.00 is due with application, payment in full 30 days before the first day of the retreat.
Fee for Begining Lomi Lomi Retreat is $1000.00. Private room $2000.00 and airport pick up and drop off in Kona.

Advance Lomi Lomi Retreat is $1000.00. Private room $2000.00 and airport pick up and drop off in Kona.

Fee includes dormitory lodging, meals(breakfast, lunch, dinner), and class instruction & massage supplies. There are separate dormitories for men and women, each dormitory has their own communual toilets & showers. Students must bring their own linens, sleeping bags, pillows, towels, laundry facilities are located on property for $.50 washer and $.50 drier.

For those who need B & B accomodations you will pay the class fee and you must rent your own room at the local B & B and get your own rent a car. We do not provide transportations to Makapala. http://www.kcadventures.com/ is 5 minutes from Makapala in the town of Kapa'au.

Fee does not include personal items ex. shampoo, tissue paper, soap, sanitary napkins, toothpaste, mouthwash, bottled water, soda/soft drinks. 

You must go to CostCo. & Wal-Mart before going to Makapala to purchase these supplies.

No transportation provided from Kona Keahole Airport for this workshop, you must rent a car or take a taxi.

Release of liability
the undersign hereby releases any and all liability and/or damage incurred during the course of the  Hawaiian Lomi Lomi Massage Art & Culture Retreat.
Furthermore, the undersigned releases Wesley Sen and Lehua McCandless-Sen, Makapala Retreat Center, their apprentices and/or agents from any and all damage and liability incurred due to negligence or the undersigned and/or of others.
The undersigned hereby agrees and understands the above:
date: ______________________

signature: _______________________________________________________

printed name: _____________________________________________________