Play Therapy - Application Form

This course has been accredited by PTUK

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1st Name*:
2nd Name*:
Address*:
Town/City*:
Postcode*:
E-Mail*:
Phone*:
Other Phone:
Please*:
	If you have worked with children, please describe your experience:
	Please state your main learning objectives - what you'd like to get out of the course:
Prior Relevant Training (This information enables us to tailor the day to participants' experience). Please list up to 4 courses in reverse chronological order.
Date of Course:
Training Provider:
Course Name:
Award:
Date of Course:
Training Provider:
Course Name:
Award:
Date of Course:
Training Provider:
Course Name:
Award:
Date of Course:
Training Provider:
Course Name:
Award:
Residential:	Please tick if you wish to be residential for the evening prior to the course.
When you are ready to send your application or enquiry please click the Submit button. Use the the Reset button if you want to start again - it will clear all the information you've typed.