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? ---13-14/06/2020 - Sound Massage I - WA15-16/06/2020 - Sound Massage II - WA16-19/5/2020 - Block Sound Massage I + II - Margaret River WA27-28/06/2020 - Sound Massage I - Perth WA29/06/2020 - KliK®1 - Perth WA19-20/09/2020 - KliK®2 - PerthWA21-22/09/2020 - KliK®3 - PerthWA19-22/09/2020 - Block KliK®2 and KliK®3 - PerthWA10-11/10/2020 - Sound Massage - Level I - Perth WA12-13/10/2020 - Sound Massage - Level II - Perth WA10-13/10/2020 - Block Sound Massage - I + II - Perth WA7-8/11/2020 - Final with Supervision - Melbourne14-15/11/2020 - Masterclass - Melbourne21-22/11/2020 - Final with Supervision - Perth23-24/11/2020 - Masterclass - Perth27-30/11/2020 - Sound Massage III&IV - Perth5-6/12/2020 - Sound Massage - Level I - WA7-8/12/2020 - Sound Massage - Level II - WA5-8/12/2020 - Block Sound Massage - I + II - WA Medical Considerations Please identify any chronic physical or emotional conditions which may impact your capacity to fully participate in this course. - 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 ——— I accept the terms and conditions of Peter Hess Academy Australia training. [recaptcha]
