New Participant Hydrotherapy Questionnaire - Canine Health and Wellbeing Academy

Certificate in Canine Hydrotherapy

Please complete this quick questionnaire:

"*" indicates required fields

Name*

First Last

Phone number*

Best email for correspondence:*

Do you meet our minimum age requirements?*

I am at least 16 years old

Please confirm the name you want printed on your certificate*

Note: Certificates are printed at the beginning of the course. Therefore, any changes required to the name on the certificate will require an additional charge and will be printed in the next scheduled print run.

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

What is your primary reason for enrolling in this course?*

Do you have any canine hydrotherapy or rehabilitation experience? If yes, please provide details:*

If yes, which facility (or facilities) have you worked at or currently work in?*

Have you had any prior education in Canine Hydrotherapy? If yes, please include the school and level of qualification achieved:*

Do you have any tertiary qualifications, certificates or diplomas? If yes, please provide details and levels achieved:*

How long is it since you have studied or completed a course?*

Once qualified, what do you plan on doing with your new skills?*