Practitioner Training at the Bach Centre

APPLICATION FORM for a Level 3 course at the Bach Centre

NOTE: THIS IS NOT AN ONLINE FORM! PLEASE USE YOUR PRINTER TO PRINT OUT THIS PAGE AND FILL IN THE FORM USING A PEN, THEN SEND TO US AS DIRECTED AT THE END.

A separate application form must be completed by each person wishing to attend a course. Put any additional information on a separate sheet and attach it firmly to the application form.

Every application received is judged on its merits. Completion of this application form does not guarantee the offer of a place on a course.

Application forms not accompanied the course fee will NOT be considered.

Complete ALL sections in BLOCK CAPITALS please.

Date__________________

A. PERSONAL DETAILS

Title (Mr/Mrs/Ms/Dr/Other) ____________________

Surname _____________________________________

First name (enter the name you like to be known by) ________________________________

Address ______________________________________________________________

_____________________________________________________________________

Post Code ________________________

Telephone ____________________(day) ____________________(evening)

Email address ____________________

Date of Birth _______________

B. QUALIFICATIONS AND WORK

Where and in what capacity are you employed? __________________________________________________________________________________________________________________________________________

_____________________________________________________________________

Please list the therapeutic qualifications you possess, with details of the training establishments you attended to achieve them:

_____________________________________________________________________

Please list any other qualifications:

_____________________________________________________________________

Are you at present undergoing any other training?_____________________________

If YES, please specify the nature of the course(s) and state their duration and finishing date:

_____________________________________________________________________

C. YOUR PRACTICE

Do you run or intend to run your own practice?____________________________

If not, explain why you want to attend a level 3 practitioner course:

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Please describe the environment where clients are or will be seen (e.g. home, therapy room attached to your home, clinic, clinic attached to health store etc.): ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

What therapies do you offer? __________________________________________________________________________________________________________________________________________

_____________________________________________________________________

What is the average number of clients you see or expect to see in a week? _____________________________________________________________________

Assuming you complete the level 3 course, apply to register and are accepted on the register, will you be in a position to accept client referrals from the Bach Centre?

_____________________________________________________________________

Do you have a restriction as to the type of client you would see (e.g. speciality fields: children, elderly, cancer patients etc)? __________________________________________________________________________________________________________________________________________

_____________________________________________________________________

Would you accept referrals solely for Bach flower therapy, without including any other therapeutic practices unless asked to do so? _____________________________________________________________________

D. RELEVANT EXPERIENCE

How long have you been using the 38 remedies:

a. for yourself? _______________________________________________________

b. for family/friends? __________________________________________________

c. for clients? (if applicable)_____________________________________________

Please describe how well you know the indications for the remedies, and the way in which you would select remedies: ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Please state what experience you have had in counselling or giving advice, (e.g. practical experience/qualified professional counsellor/less formal training):

Do you possess any other special skills or qualities that would be an asset to a Bach Foundation Registered Practitioner? (Continue on a separate sheet if necessary.)

E. SELECT YOUR COURSE

Please tell us the start date of the course you want to attend:

_____________________________________________________________________

If your first choice is full, which if any other courses could you attend?

__________________________________________________________________________________________________________________________________________

F. PAYMENT

The current course fee is £540.50. Note that your credit card will be debited on the day that you are assigned a place, and if you cancel your booking after this time there will be a cancellation fee of £140 to pay.

You can pay using Visa, Delta or Mastercard credit cards. Which do you want to use?

_____________________________________________________________________

Please write down your credit card number:

_____________________________________________________________________

And the expiry date on your card:

_____________________________________________________________________

Card verification number (last three numbers on the signature strip on the back):

Please write down your name as it appears on the credit card:

_____________________________________________________________________

Finally, please sign to confirm that you want us to debit your credit card with the course fee:

_____________________________________________________________________

G. SEND EVERYTHING TO US

Please send this application form together with a COPY OF YOUR LEVEL 2 CERTIFICATE (or proof of having enrolled on a Level 2 course) to:
Course Applications

The Bach Centre

Mount Vernon

Brightwell-cum-Sotwell

Oxon

OX10 0PZ

UK
Alternatively, fax everything to 00 44 (0) 1491 825022

Places will be allocated to suitable applicants on a first-come-first-served basis. Credit cards will be debited and cheques cashed on the day that you are assigned a place. If you cancel your booking after this time there will be a cancellation fee to pay. If your application is not successful your cheque will be returned to you, or your credit card will not be charged. Application forms not accompanied by full payment will not be considered.

VAT Reg. No. GB 757 2726 05

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