ELISTA Education - Education & Training in Animal Assistance & Therapy

learner zone

	Ethical Animal Use
	Canine Behaviour & Training
	Assistance Dog Training
	Canine Training & Instructing
	Human - Animal Interactions
	Animal Assisted Therapy
	Equine Handling, Husbandry & Instruction
	Equine Assisted Therapy & Learning
	Animal Welfare
	Animal Rehabilitation

HUMAN - ANIMAL INTERACTIONS REGISTRATION FORM

Please complete all sections to the best of your ability.

The information provided will be treated confidentially as per data protection regulation. ELISTA Education does not share data with third parties. Information supplied is used to ensure this is the most suitable course for you (as per quality assurance), if we have any concerns or queries we will contact you by telephone. Please ensure all details are correct.

Course Delivery

Which Human - Animal Interactions course do you wish to participate on?

Home Study Course

Personal Details

Name:			Home tel:
Address:			Work tel:
			Mobile:
			Date of birth:
			Nationality:
Email:

Previous Education and Training

Leaving Cert (or equivalent), subjects & grades:

Year of Leaving Cert (or equivalent):

Other education & training (please enter year, level & details):

Current Employment/Training (if applicable)

Name of employer/company:
Job title:
Hours worked per week:	40+ 30-40 30-20 20 or less

Work With People or Animals

Have you ever worked or volunteered with people and/or animals? Yes No

If yes, where?

Dates (from and to):

Brief details of job(s):

Your Animals(s)

Details of your animals(s) (please enter species, age and any specific activities/details):

Have you attended any relevant classes, events, activities or seminars? Yes No

If yes, when and where?

Your Interest in ELISTA Education

Please use the space below to explain why you wish to participate in the ELISTA Education Human - Animal Interactions Course.

Declaration

I confirm that the details given above are true and correct.	Please Confirm
I have read and agree to the ELISTA Education Terms & Conditions Refund Policy.	Please Confirm