Hawaiian Healing Adventure - Application Form
We are offering a six night Camping Retreat Experience on the north-shore of Kauai. Your answers here are the first steps toward booking a video chat with Wayne. The zoom call will be about 30 mins to determine if you will be a good fit with the others who are joining this adventure. We are so happy that you have come this far! 

Make no mistake---this Healing Adventure/Retreat is designed to offer you an experience of Heaven on Earth. These sacred journeys usually fill up pretty fast, so please don't hesitate to apply if your heart is calling you to Kauai! Once we receive your application and have time to review it, you will get an email to arrange your video appointment with Wayne. After you've been accepted, you can make payment and you will receive confirmation.  
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Email *
Full Name *
Phone Number *
Full Address (street number, street, city, province/state, country, postal code) *
Birthday  *
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Who is your emergency contact person? And what's their phone number (incl country code outside USA) *
Are you applying for the Dec 14~20, 2023 Hawaiian Healing Adventure? *
How many are you applying for?  *
If you're a family, how many are in your family?  *
If you're bringing children, how many?  *
If you are bringing children, what ages are their names and ages?  *
Why are you interested in this Healing Retreat Adventure? *
Please share just a bit about yourself with us here...
*
Do you like to Camp, Swim, Hike and Kayak? *
What are your most challenging personal issues right now? 

*
Please share with us about any health conditions or concerns you may have about yourself or any member of your family *
Would you be able to hike 5 miles in one day? *
Are you ready to commit to attending this healing adventure? *
Are you able to pay the Early Bird discount price in full before Sept 14th?  *
Or do you prefer to pay a non-refundable deposit toward the full price now and the balance by Nov 14, 2023?
*
Do you have any questions (or concerns) for us? *
What time zone will you be in for our Zoom video call? *
What day and time works best for our zoom call? 
(Please give us a few options)
*
Thank you so much for your interest in this Kauai Adventure! We will get back to you very soon... *
Hawaiian Healing Adventure with Wayne Kealohi Powell on Kauai
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