Swell Surf Foot Interest Form

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Swell Prototype Waiver* This field is required.Swell is still in the development phase and is currently a prototype. It has been developed alongside amputees during each stage. Swell has been tested throughout its development on the land. We are now conducting tests in the water. Signing below acknowledges that Swell is 1) not a fully realized product and still a prototype, 2) some risk comes with testing the device 3) we are not responsible for any injuries
Clear
2
Let's start with your First and Last Name.* This field is required.Glad to have you onboard!
First Name
Last Name
3
What email address can we reach you at?* This field is required.We have lots of test footage and development we would love to share with you!
example@example.com
4
Got an Instagram? Drop it below so we can give you a follow!
5
We would love to talk in person! Drop your line below so we reach out!* This field is required.
Area Code
Phone Number
6
How did you hear about Swell?
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Where do you live?* This field is required.Just so we can estimate shipping costs for the prototype!
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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How would you describe your level of surfing* This field is required.
I am completely new to the sport (never surfed before/after amputation)
I surfed before my amputation, but haven't surfed since
I feel comfortable surfing with my existing foot, but it's hold me back (Intermediate)
I've been shredding waves now for years (Advanced)
9
Tell us a little about how you started surfingNot required but we love to hear peoples stories!
Huge
Large
Normal
Small
Ok
Ok
10
If possible can you give details of the current foot you use at the beach to surf?Feel free to add any frustrations you might have with the current foot. You will be able to attach a photo on the next question.
Huge
Large
Normal
Small
Ok
Ok
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Photo of current footNot required but appreciated!
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
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Almost Ready to Surf...Swell is a little over 4.5'' tall (4.66'' to be exact)
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Does this work with your existing pylon? * This field is required.
YESNO
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If no, how long does the pylon need to be? We can have one fabricated 15 inches
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Do you have a GoPro or action camera to capture footage of yourself using Swell?* This field is required.
YESNO
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If so what kind?Name and model
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Once you receive the Swell Prototype, how soon could you test it?* This field is required.
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We are still in the testing stages of Swell (and we know you have yet to try it!), but if we were to bring it to production how much would you be willing to spend on Swell?We will ask this again once you have had a few sessions with Swell!
Price in $USD
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