~ Canadian Healing Arts Institute ~ Registration

For more information:
Canadian Healing Arts Institute
Rossland, BC
PO Box 300
Canada V0G 1Y0
Local: 250-362-9481
sidandbonny@telus.net

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Application for Registration
First Name:
Last Name:
Date of Birth :	/ /
Street Address:
Street Address (2):
City:
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Zip/Postal Code:
Country:
Phone (Home):
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Additional Information

Citizenship:
Place of Employment:
Address of Employer:
Fluency In Languages:
High School Name:
Year Graduated:
High School Address:
Post Secondary Education:
Any current licenses or certificates in Healing Arts:
Personal Experiences in Healing Arts:
Financial ability to cover cost of tuition:	/ If Other:


Contact Email:

Special Notes:

I certify that the above information is true and correct to the best of my knowledge. I agree that as a condition of my participation in the Canadian Healing Arts Institute, I will comply with all the rules and regulations of the Insitute. I agree that I have read the Liability Waiver prior to submitting the application. Agree: Today's Date:

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Billing Information
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