Aqua Therapy Certification Course

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Which class date(s) would you like to be considered for?*

Will you be over the age of 18 when you take this class?

Do you currently work with dogs?*

YesNo

Do you have experience working with people, if yes please describe? If no, what is your current occupation?*

What types of pervious training do you have, if any, working with animals or people? What classes have you taken?*

Do you have any certifications? If yes, please list certifications and the school where they were received at.*

What is your experience being in the water and/or swimming?*

Additional comments relevant to this application:

Course Tuition = $2,600 USD

The class size is limited to 4 people. Upon approval, we will notify you via email to pay the deposit of $500, officially reserving your space in the desired class. Deposits are non-refundable. You can transfer to another class date within the same calendar year of your original class date upon approval. Late cancels/changes will be subject to an additonal fee of $100 for 30 days - 90 days prior to the start date of class or $200 for 29 days or less prior to the start date of class.

Signature*

By signing this application, I agree that I am registering for a program through School of Pet Aquatics, for the purposes of providing me with training in Canine Aqua Therapy. I understand that completion of the program does not give me legal license to practice, nor does it satisfy any legal or state requirements of any kind. I further agree to assume all risk, and to release and hold harmless School of Pet Aquatics, Aqua Therapups LLC, and its principal Rebecca J Pease from any and all liabilities. It is my express intent that this shall also bind the members of my family and all respective heirs, executors, administrators, legal representatives, successors, and assigns, and shall be deemed as a RELEASE, WAIVER, DISCHARGE AND COVENANT NOT TO SUE the above named RELEASEES. I hereby further agree that this shall be construed in accordance with the laws of the State of Wisconsin. I understand that upon receipt of this application, School of Pet Aquatics will confirm availability.