Canadian School of Colon Hydrotherapy A Career in Colon Therapy Registration Form Applicant Name:* First Last Address Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Date of Birth Date Format: MM slash DD slash YYYY Cell PhoneHome PhoneEmail In Case of Emergency - Contact Name & PhoneCustom dates available for one-on-one training for no additional charge 5-DAY INTENSIVE PROGRAM* (1-2 students) (*larger groups add an extra day) Colon Hydrotherapy Certification Course 4-DAY INTENSIVE PROGRAM* (1-2 students) (*larger groups add an extra day) Colon Hydrotherapy Certification Course 1-DAY BUSINESS PROGRAM Available as a stand-alone program for all Colon Hydrotherapy practitioners (new or existing) and/or people considering opening their own business. 4-HOUR EQUIPMENT TRAINING Available as a stand-alone program for all certified Colon Hydrotherapy practitioners DIGESTIVE CARE ADVISOR PROGRAM Product knowledge for an entire line of supplements, Certificate of completion through Renew Life Canada ASSOCIATION MEMBERSHIP C-ACT Membership to (C-ACT) Canadian Association for Colon Therapists / Volunteer positions available in lieu of membership fees Indicate Choice of Programs & Deposit PaidCourse Selection*5-Day INTENSIVE Program $29004-Day INTENSIVE Program $24001-Day Business Program $650Equipment Training – Aquanet EC-2000 $400DepositMembership to Canadian Association for Colon TherapistsMembership Fee $200Total $ 0.00 CAD Payment MethodChoose OneCredit CardChequeEtransferCard NumberExpiry DateYearMonthCVVPlease Mail Your Payment to: CANADIAN SCHOOL OF COLON HYDROTHERAPY 2351 Kennedy Road Unit 126, Scarborough, Ontario, Canada, M1T 3G9Please Send Your Payment to: email@example.com 416-291-4437 COURSES INCLUDE: A detailed course outline and binder will be provided on the first day of the course Refreshments will be provided during morning and afternoon breaks daily TERMS AND CONDITIONS: Tuition fees quoted do NOT include HST Lunch and dinner is NOT included - Local restaurant list available Accommodations are NOT included Guests suite may be available at a cost of $75 per night Each program may vary in times and hours depending on the number of participants. The daily schedule may be changed at any time without notice as needed. $500.00 (non-refundable) deposit due at time of registration. All tuition fees must be paid in full prior to the start of the course Payments preferred with cash, Debit or EFT Tests - last day of the course. We will ensure you have an opportunity to re-sit tests. Your certificate will be given upon successful completion of the course. REQUIREMENTS & WAIVER: I understand that upon successful completion of the course including case studies I must pass a series of tests to meet the CSCT requirements of Certification. Release: "I hereby release Canadian School of Colon Hydrotherapy and/or Free to Play Inc., and all branches and affiliations from all claims of damages arising from any accident or injury which is caused by or arises from participation of the applicant named herein, during any program or any facility or any location where a program is held". Confidentiality and Disclosure: Absolutely no part of the content in the copyrighted publications, course material or teachers’ notes, may be photocopied or adapted for teaching purposes or shared with anyone not taking the CSCT program. Breach of these restrictions will result in legal action. I certify that I have read and understood the items outlined on this registration form.NameThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.