Application formInformation required to see if you qualify to become a trained colonic Hydrotherapist.Application FormPlease enable JavaScript in your browser to complete this form.TitleName *FirstLastGender Date of Birth Nationality Address Inc Postcode Home Phone:Mobile Phone:EmailOther Therapies: Do you currently practice any other therapies? (Please give details) You will need to provide copies of your certificates.Educational Qualifications: Please give details of any other educational or professional qualifications. You will need to provide copies of your certificates.Do you have any criminal convictions? YesNoHave you had any claims made against you in regard to your practice? YesNoAre there any claims currently outstanding against you? YesNoHave you ever been refused insurance or been given special terms or increased premiums?YesNoHave you ever been the subject of a disciplinary procedure by a professional or regulatory body?YesNoHave you ever been struck off a professional register? YesNoHave you ever been refused insurance because of malpractice, criminal offences or other reasons?YesNoPlease provide details if the answer to any of the above is Yes.Do you hold a current EFAW (Emergency first aid at work) certificate?YesNoIt is a requirement for RICTAT members to hold a current first aid certificate (Valid for 3 years) Please provide a copy of your certificate. If you do not have this must be in place prior to trading as a colon hydrotherapist.Are you registered with the Information Commissioners Office or your Countries equivalent? *YesNoIt is a requirement for RICTAT members to be registered in the UK with the Information Commissioners Office or for an International Members their national equivalent if applicable. A copy of your registration certificate to be submitted. If you do not have this it must be in place prior to registration with rictat as a colon hydrotherapist.Do you have a valid Disclosure and Baring Service (DBS) Certificate or your Countries equivalent? *YesNoIt is a requirement for RICTAT members to be undertake a Basic check the UK with the Disclosure and Baring Service or for an International Members their national equivalent if applicable. A copy of your certificate to be submitted. If you do not have this must be in place prior to registration with rictat as a colon hydrotherapist.I declare that the information I have given is correct and complete. If any of my circumstances change, I will notify RICTAT immediately, including any contact details. *Signed: DateSigned and Dated Registration FormThank you *Thank you for registering with Colonic Trainer By Erica Hartley. We will be in touch if we need any more informationPlease upload proof of ID if possible Click or drag a file to this area to upload. By submitting this form you are adhering to the terms and conditions of the RICTAT and Colonic Trainer By Erica Hartley Training courses.Submit
