REGISTRATION FORM 2025 LEVEL 1 AND LEVEL 2 ON-LINE COURSES Please enable JavaScript in your browser to complete this form.Name *FirstLastPlease take care with the name with which you correspond and register. You will not be able to change the name you registered with once you have started the on-line course. Cellphone number *Email *Home phone number phone to supply Work phone numberProfessional Board *C4CSAHPCSAOTSACESACSSPOtherProfessional Board NumberQualificationsExperience with childrenMy application was successful *YesIf you have not applied and been successful, please apply on the website before submitting this form ( click here ).I would like to Register for Online Course/s *Level 1 Beginners Course [R2850]Level 2 Advanced Course [R2850]Book [included with registration & payment of both courses ]Book [R599]Closest PostNet to receive hard copy of the bookIf you register for Level 1 & 2 together, and pay both courses you qualify for a complimentary hard copy of the book: A Gestalt Intervention Framework for Play Practitioners 500 pages. The book is required for Level 2. All certificates are sent by email in PDF format, which you can print yourself. When completing both Level 1 and 2, the electronic certificates will be sent together on successful completion of Level 2.Date you plan to start LEVEL 1Date you plan to start LEVEL 2When registering for Level 2 Advanced Course, please supply your Level 1 Certificate numberIndicate clearly your preferred name for your Certificate *Signature *Date *Required *I agree to the Terms & ConditionsAll course material is only available to successful applicants who have registered and paid for the courses. Please tick to agree that you have read and understood our terms and conditions and you hereby agree that you will not duplicate or distribute any written or video material to any other person or entity. Payment instructions will follow by email once we have received your form.Submit