formulier

Registration form
Personal info:
Surname *
Initials *
Name *
Date of Birth *

Day Month Year
Gender *
I am new to the school *
Address:
Street *
House number *
Post code *
City *
Country *
Reachability:
Phone number *
Extra Phone number
E-mail *
Profession
Current education level

High School College University Bachelor University Master Para Medical
Current level N.S.K.S.
How did you hear about the school?

Internet Newspaper add
I would like to subscribe myself for the following: (Multiple options possible) *

Course (Basic course - Do-In for women) *) Seminar (Year Y. Kawada Sensei - Diagnostics - Moxa - Meridian - Lunteren - Macrobiotic cooking) *) Diploma Course **) Diploma Course Exams ***)
Course *)
Start date of the Course

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I would like to subscribe for a second course

Yes
Second Course *)
Start date of second Course

Day Month Year Date Picker Icon
To view Course dates, click here. (This link will open in a new page)

_______________________________________________________________________________
Seminar *)
*) Accredited as postgraduate education- higher vocational education
Start date of the Seminar

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I would like to subscribe for a second seminar

Yes
Second Seminar *)
*) Accredited as postgraduate education- higher vocational education
Start date of second Seminar

Day Month Year Date Picker Icon
To view Seminar dates, click here. (This link will open in a new page)

_______________________________________________________________________________
Diploma Course **)
Start date of Diploma Course

Day Month Year Date Picker Icon
To view Diploma Course dates, click here. (This link will open in a new page)

_______________________________________________________________________________
Diploma Course Exam ***)
Start date of Exam

Day Month Year Date Picker Icon
I would like to subscribe for a second Exam

Yes
Second Diploma Course Exam ***)
Start date of second Exam

Day Month Year Date Picker Icon
Your exact name to be written on your Certificate/Diploma:
To view Exam dates, click here. (This link will open in a new page)

_______________________________________________________________________________
Comments:
Judicial declaration:
I am over the age of 16 *

Yes No
If you are 16 or younger we need an e-mail confirmation from your parents, guardian or provider before registrating. The e-mail should state that they formally give you permission to enter the Diploma course or Seminar you subscribed for. They can send an e-mail to klassieke@shiatsu.nl. As soon as we have received this e-mail you can proceed your registration.
I give permission to share my adress information with fellow students *

Yes No
I would like to receive the school's Digital Newsletter *

Yes No
Undersigned declares to have filled in the form truthfully, to agree with the General Terms and Conditions and to be informed of the payment terms both as described on www.shiatsu.nl
Enter the message as it's shown *
*) Admission occurs by chronological order of received payment.

**) Undersigned has read, understood and agrees unconditionally with the general terms and conditions set by the Dutch School for Classical Shiatsu to be allowed to take part in a level on the diploma course. The total amount of a diploma course level is € 1100,- (incl. submission fee of € 350,-). If the whole amount is being paid at once, with a minimum of one month before commencement of the level concerned, a discount of € 45,- is being granted. There is a possibility to receive a payment contract, only when requested largely in advance at the secretariat. In this case the full amount has to be paid within three months after commencement of the level concerned. The submission fee will be € 390,-, the total amount for the diploma course level € 1100,- + administration costs. Admission occurs by chronological order of received payment.

***) Undersigned has read, understood and agrees unconditionally with the general terms and conditions set by the Dutch School for Classical Shiatsu to be allowed to take part in Exams. The examination fee of € 75,- ( € 85 for Level 4) must have been paid to the account number mentioned below at the latest of one month before the examination date, indicating the examination level and examination date.
Secretariat: Stuyvesantstraat 24, 2593 GM Den Haag

Phone: 070 - 383 15 00

E-mail: klassieke@shiatsu.nl

K.v.K (Den Haag): 27156302 - Bank: NL38ABNA 056.84.25.502

https://www.shiatsu.nl
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