Enrolment form

Name

Address

Date of Birth

Phone number

Your Email

Emergency contact

Please indicate which Peter Hess Sound Massage training you are registering for?

Medical Considerations

Please identify any chronic physical or emotional conditions which may impact your capacity to fully participate in this course.
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I am pregnant.

YesNo

I am fitted with a Pace Maker.

YesNo

I am taking prescribed medication.

YesNo

I suffer from a serious mental illness.

YesNo

Other.

YesNo

Media Consent
By ticking the media consent box, you agree to PHAA taking photographs or videos of you as a participant. These images may be used for promotional material (included printed, digital or online format).
I agree.I do not agree.

Previous Training

Please list all previous training in Peter Hess Sound Massage Method and attach a copy of course certificates

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I accept the terms and conditions of Peter Hess Academy Australia training.

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