Application Form

 

 

  
Name of Course: Itec Holistic massage
Venue:
Name:  
Address:  
Contact Number:  
Email Address:  
   

Payment: All major Credit/Debit Cards accepted. Cheques made payable to "Heatherwood Academy"

Full Payment 14 days prior to course commencement is required.

A 50% deposit can be placed providing the course duration is longer than one day and the start date is not less than 4 weeks from booking.

Refund policy: no refunds can be given due to the nature and length of the courses. In exceptional circumstances another date may be offered at a cost of £25.00 for administration costs.

We reserve the right to change the tutor, venue and time.

We run courses on the basis of a minimum of 4 students. In the unlikely event of this number not being reached we reserve the right to cancel the course and transfer the booking to next scheduled date.

*N.B* If in the event of competency not being attained we reserve the right to administer a £45.00 charge for re-examination.*
   

I acknowledge the above. Signed: ..................................................................................................

   

Post application with Health Questionnaire and payment to:

Heatherwood Academy
Copthall Farm
Breakspear Road South
Ickenham
Middlesex
UB10 8HB

Queries: 01895 673777 (answerphone) Hrs. 9.00am - 5.00pm
Email us: heatherwoodacademy@yahoo.co.uk
   

 

Health Questionnaire

All students wishing to participate on a workshop will be required to complete this form in order to insure all safety aspects have been covered and the person is fit to give and receive a treatment. Please return form with application

Please circle your answers.
Are you currently on medication? Yes No
If Yes, please provide details    
Are you currently receiving any kind of treatment or therapy? Yes No
If Yes, please provide details    
Do you suffer with High or Low Bp? (please indicate which one) Yes No
If Yes, please provide details    
Do you suffer from muscular or skeletal problems? Yes No
If Yes, please provide details    
Do you have any skin sensitivity ? Yes No
If Yes, please provide details    
Do you have any allergies? Yes No
If Yes, please provide details    
Do you have any disabilities ? Yes No
If Yes, please provide details    

The answers given are to my knowledge true and I agree to give and receive treatments whilst on this course.

Signed: ..................................................................................................