FOUNDATION COURSE QUESTIONNAIRE

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Dear participants of the Equine Shiatsu Foundation Course, please fill out the following questionnaire. This is only an informative questionnaire for us to organize the course more efficiently for you to learn as much as possible and to make your learning more enjoyable.

NAME *

E-MAIL *

PHONE *

DATE OF BIRTH *

YYYY

ADDRESS *

Do you have any experience around/with horses? If yes, please explain briefly. *

Do you have any experience with Shiatsu? If yes, please explain briefly. *

Have you any experience with other alternative/complementary therapies? If yes, please explain briefly. *

Do you suffer from any of the following:

Learning difficulties

Poor eyesight (incl. wearing glasses)

Poor hearing (incl. wearing hearing aid)

Heart problems

Joint problems that prevent you from bending or working on your knees

Any other relevant medical condition

If you do suffer from any of the above conditions, please explain briefly. *

The Foundation Course follows the programme of The School of Equine Shiatsu, UK. The Course and all course materials are in English. Are you able to follow lectures in English and read English? *

Please read carefully the following statement. I confirm that I am over 21 years of age and feel competent and confident working around horses. I understand that working with horses is my own choice and risk and I agree to indemnify The School of Equine Shiatsu and the co-organiser Udruga u Šumi, its directors and teaching staff against any injury, illness or accident, howsoever caused to myself or vehicle whilst attending courses at any time. By answering YES I confirm I have read and agreed to the above statement. *

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