CSAM | Certification | Application

Basic Small Animal Massage

Certification Course Application
Submission Date

MonthDayYear
Applying for:*
Thank you for your interest in science-based education!

We look forward to seeing you in class!

Student Information
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Email*
example@example.com
Phone*
Street Address*
City*
State/Province*
Country*
ZIP/Postal Code
Upload a headshot.

Don't have a headshot yet? Send it to us later, by email.
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Animal Handling Experience (minimum 50 hours)*

Upload your resume.

Need to polish your resume up a bit? Send it to us later via email....but remember, your application is incomplete with out it!
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Professional References*

	Name	Title	Relationship
Veterinarian
Other Professional (instructor, employer, manager, colleague, etc.)

Permission and Waiver
I, {firstName} {lastName}, grant permission to the Colorado School of Animal Massage, hereinafter known as the “Media” to use my image and/or my animal’s image (photographs and/or video) for use in Media publications which may include videos, email blasts, recruiting brochures, newsletters, magazines, general publications, website and/or affiliate websites, and social media.
I hereby waive any right to inspect or approve the finished photographs or electronic matter that may be used in conjunction with them now or in the future, whether that use is known to me or unknown, and I waive any right to royalties or other compensation arising from or related to the use of the image.
Initial to acknowledge*
I am 21 years of age or older and I am competent to contract in my own name. I have read this release before signing below, and I fully understand the contents, meaning and impact of this release. I understand that I am free to address any specific questions regarding this release by submitting those questions in writing prior to signing, and I agree that my failure to do so will be interpreted as a free and knowledgeable acceptance of the terms of this release.
Initial to acknowledge*
Method of Payment

Ruzuku
Status

Application Received
Requested Date*
Should be Empty:

Basic Small Animal Massage