Dolphintherapy course registration form

Please fill out this form after we have confirmed your spot in our education program.

Positions marked with * are obligatory. These fields must be filled out that the form can be submitted.

First name:* Family name:*

Street:* No.:* Fl*: Apt.*:

Loc.:* ZIP:* Country:*

Tel.No:*
(f.Ex..: 0043 660 123456)

E-Mail:*

Date of birth:*

Sex:* Male Female

Present Occupation:*

My prefered date for theory :*

Your travel information to the theory seminar if available:

Hotel

Flights (arrival / departure )

My prefered date for practice :

Preferred location of the practice:*

Your travel information to the practical module if available:

I want to stay during my practical at the DOLPHINSWIM students accommodation.

No, I don´t want this. I stay in the Hotel:

Flights (arrival / departure )

AGREEMENTS

I agree that the dolphin therapies will be photographed and recorded on Video
I agree that my therapy photos will be published on the dolphinswim AlphaTherapie facebook site

Curriculum and terms of business download

I have read the curriculum and accept the terms of the program

Note: After you have completed this online registration DOLPHINSWIM Institute will send you the registration confirmation and invoice. The registration is completed with the payment of the registration payment. The payment plan includes 3 payments: EUR 150.- at registration (this payment must be taken within 2 weeks), EUR 690.- 2 prior the theory seminar and EUR 1660.- prior the 4 week practical education. We will inform you by email on the exact therapy time 3 days upon arrival at the therapy.

Digital signature: Please type the letters in the field below. Consider the use of capital letters: