Hypnotherapy Training Enrolment form

Yorkshire Hypnotherapy Training

Keldale House, Beal Lane, Beal, DN14 0SQ
This form is to help me decide if I can offer you a place on a training course with Yorkshire Hypnotherapy Training.

You will generally hear from us within 48 hours of your form arriving here. We will arrange an informal chat on the phone or by Zoom to make sure all your questions about the course are answered and to ensure you're a good fit for the class.

If you prefer not to submit personal details online, you can download a blank form from the 'enrol now' page of the website and send it to us by post. Thank you.

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Data Protection

Please read my data protection policy on https://www.yorkshirehypnotherapytraining.co.uk/cookies before submitting this form. It tells you how I collect, look after and use your personal data.
Under the GDPR, you need to agree to each separate use of your data. You can withdraw permission for any of these uses at any time by letting YHT know in writing.
I have read your privacy policy and agree to Debbie Waller using my personal data: *

to answer queries and provide you with support to decide if we can offer you a place on one of our courses to administer the course once you are enrolled to collect payment and maintain records to contact any third party involved in your enrolment (e.g. someone who is funding the course)
When you submit this form, we will also sign you up for the YHT monthly email newsletter. This is a legitimate business use of your contact details, since it's important for students and those waiting for courses to start to keep in touch with our activities. You can opt out at any time by unsubscribing using the link at the bottom of one of the newsletters.
When we offer you a place, we will also sign you up for the YHT monthly newsletter if you are not already subscribed. We believe this is a legitimate business use of your contact details, but you can opt out if you wish by unsubscribing.
Newsletter: When you submit this form, we would also like to sign you up for the YHT monthly newsletter (if you are not already subscribed). It's a good way to keep up with what's going on in the school and has links and tips that will be useful once you are training. You can unsubscribe at any time. Please indicate your agreement to this use of your data here.

Yes, subscribe me to this newsletter.
Signed (type your name if completing the form online) *
Today's date: *

Day Month Year
About you
Your name as you would like it to appear on certificates *
What do you prefer to be called if different (e.g. nickname)?
Email *
example@example.com
The best phone number to contact you *
Is it OK to leave a message on that number? *

Yes No
Address including post code *
Emergency contact (name and phone number) *

Your background and medical history

These questions are relevant to your ability to practice as a therapist, and/or to enable you to be hypnotised safely in classroom exercises. A ‘yes’ answer does not usually prevent you from taking the course, and your answers will be kept confidential.

If you have any queries about how these issues might affect your enrolment, please feel free to contact us for advice. 01977 678593.
Please tick any/all of the following that apply to you *

I have unspent convictions under the Rehabilitation of Offenders Act 1974 I take long term prescription medication In the last 3 years I have undertaken some kind of psychotherapy, counselling or hypnotherapy I have suffered addictions (other than smoking) I have experienced an eating disorder which needed medical attention I have been diagnosed with type 1 diabetes I have been diagnosed with epilepsy I have been diagnosed with a psychosis, personality disorder or learning difficulty None of the above apply to me
If you have selected 'none of the above apply to me', leave this box blank. If you have ticked any of the other options, please give us a bit more detail here.

About you
Are you over 21? *

Yes No
Have you completed a YHT Taster Course? *

Yes No
Do you have any other experience of hypnosis or hypnotherapy? *

Yes No
Are you trained in any other kind of therapy? *

Yes No
Why do you think you should be offered a place? (This is your chance to sell yourself: tell us about your skills or experience and/or why you would like to come on the course)
If there is any other information you'd like to give that didn't fit elsewhere on the form, please put it here. Examples might be your preferred pronouns, or if you need support to undertake the course or assessments (e.g. due to dyslexia, a disability or medical issues) or your preferred times to arrange a chat.
Declaration

By submitting this form you are accepting that
- places are offered on the basis of the information you supply and you affirm that this is true and complete
- the format, date and venue choices are offered on a provisional basis since classes can only run if student numbers are viable
- we reserve the right not to offer you a place if classes fill or if we feel you are not a good fit for our course
PLEASE NOTE. Email is pretty reliable but very occasionally messages go astray. If you have not received our reply to this form within 48 hours, please phone Debbie on 01977 678593

A word before you press the 'submit' button!
A copy of this form will be sent to you, but since it contains sensitive data it will be password protected. The password you need to open it is YHT (capital letters, case sensitive).
I suggest you write that down now as it won't be in the email; if you mislay it, you can always request it from Debbie.
Should be Empty: