The Craniosacral Therapy Educational TrustApplication Form for Practitioner Training in | ||
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Name ...................................................................... Address................................................................................................................................ ............................................................................................................................................ ......................................... Postcode .................................... Phone No ...............................(Home) ...........................................(work) email.............. ...................................................................... | ||
| Profession:................................................. Age: ................... Date of Birth:..................... M/F:............................... Family/Relationships (married/partnered, children).......................................... Formal Education: Education, Degrees and Training(Degrees/Certificates Completion Date Length of Training etc.) ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. Professional Qualifications (e.g. Association, Registration, etc.) ....................................................................................................................................... ................................................................................................................................. Description of Professional Practice (Nature of Practice, clients per week, years in Practice)............................... .................................................................................................................................... ................................................................................................................................. Training in Anatomy and Physiology (course, hours of tuition)................... ......................................................................................................................................... ................................................................................................................................. Previous Craniosacral Therapy Training...................................................................... ................................................................................................................................. Course Length of Course and hours of Tuition................................................................ ................................................................................................................................. | ||
Health ProfileCurrent State of Health (illnesses, symptoms)........................................... .................................................................................................................................... ................................................................................................................................. Current and Past Medication (Prescribed drugs, recreational drugs - including alcohol/amount per week) .................................................................................................................................. ................................................................................................................................. Medical HistoryPhysical (physical illnesses, accidents, falls, etc.)..................................... ............................................................................................................................. ................................................................................................................................. Psycho-emotional (psychiatric, psychological processes that affected your functioning or well being) ................................................................................................................................. ................................................................................................................................. Hospitalisations, Surgery (for physical or psychological reasons).......... ................................................................................................................................. ................................................................................................................................. Birth History and Childhood (any known details, any relevant history)........ .................................................................................................................................. ................................................................................................................................. Current Therapy (current therapeutic modalities that you are experiencing as client/ patient) ................................................................................................................................. ..................................................................................................................................... Past Experience of Therapies (modalities that you have experienced as client/ patient) ................................................................................................................................. .................................................................................................................................... Past Criminal Record (any criminal convictions)............................................... ................................................................................................................................. Any Other Relevant Information:................................................................................... .................................................................................................................................... Any Other Information to Support Your Application: .................................................................................................................................. .................................................................................................................................... ................................................................................................................................. Please tick this box if you are concurrently applying for the 'Living Anatomy' foundation course. | ||
Personal ResponsibilityThe course is designed to provide insight and direct experience of this therapeutic approach. However, the course is not intended to be, nor may it be assumed to be, a treatment or cure for any existing complaint or illness, or for any complaint or illness which arises during the training period. It is the personal responsibility of each participant to secure a programme or support for their own personal well-being which is independent of the training programme. This may include seeking the assistance of a professional Craniosacral Therapist between seminars to address any issues which arise during the seminar and training period. All information that is asked for is given on a voluntary basis and is held in strictest confidence. None of the information, except the name, address and telephone number, is held on a computer database. Financial ObligationsI understand that once I have been accepted onto the training, if I withdraw before the start of the course my deposit is non-refundable if my place cannot be filled. If a deposit is refunded, a £100 administration fee will be deducted. I understand that I am committing to the entire training programme and its tuition fees. All instalment payments during the training period are non-refundable. Please note that the course fees (or the first payment if paying by instalments) are strictly due two weeks prior to the start of the course. I enclose a £20 application fee and a photocopy of any professional certificates. This is a non-refundable administration fee and is separate from the course deposit and course fee. A course deposit of £500 will be due within two weeks of being accepted onto the training to confirm my place.
Signed: ............................................ Date:.................................................. | ||
| Please send completed application for together with your application fee to: Craniosacral Therapy Educational Trust,The Administrator, 78 York Street, London W1H 1DP, UK |