Name
*
First Name
Last Name
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Date of birth
*
MM
DD
YYYY
Email
*
Phone number
*
Do you have any experience of giving massage?
*
Do you have any experience of receiving massage, bodywork or holistic therapy?
*
If so, which type? E.g., Sports or Thai massage, Reiki, Craniosacral Therapy, Chiropractic, Reflexology etc
Why do you want to do the course? What are you hoping to gain or achieve?
*
This could be for personal development, to start a new career, pick up practical skills, anatomy knowledge, etc
What do you hope will be different by the end? What will have changed in you and/or your life situation?
*
Examples include: confidence in working with the body, more ease and relaxation in my own body, start a job where I can have more time with my family
Do you have any medical conditions I need to be aware of that may affect you during the course? Eg asthma, high or low blood pressure, joint injuries, etc
*
In the last 5 years, have you had any major accidents, operations, injuries or illnesses? Or, any of these at any point in your life that still affect you?
*
Are you taking medication or waiting to see a doctor?
*
Do you have any allergies, particularly anything that affects your skin?
*
Do you need learning support to participate in the course?
*
For example - large print or blue paper handouts, mobility aids, etc
Do you need any life circumstance support to participate in the course?
*
For example, information about childcare or financial support, contact for a counsellor, etc
Are there any circumstances in your life that may affect your participation in the course? How do you plan to manage this alongside the course workload?
*
For example - demanding job, caring for elderly relative, recent bereavement, financial pressures
Do you have any experience of anatomy, physiology and pathology?
*
As part of your work, advanced (A-level plus) study or as a hobby
Do you engage in any creative or personal practices to help support and nourish you, including fitness and exercise?
*
For example: yoga, meditation, art journaling, dance, Tai Chi, dog walking, gym work etc - please say what practices you do and how they help you
Do you have an Emergency First Aid at Work certificate, with 1.5 years or more left to run?
*
Is there anything else you would like to add to support your application?
