Center for Natural Balance Horse Dentistry

4thorse@gmail.comR E G I S T R A T I O N F O R M

To register for any Center for Natural Balance Horse Dentistry class please do the following:

1. Email us to ensure there is still space in the class.2. Complete, sign, and date both pages of the registration form and email to us, send your deposit via paypal

Please print clearly:

Name______________________________________________________________________________

Address_____________________________________________________________________________

_____________________________________________________________________________

Phone: ( ) ________________________ Cell Phone ( ) ___________________________

Email______________________________________

Emergency Contact Name & Number______________________________________________________

Gender ________Male _________Female

Occupation_______________________

Prior Equine Experience: Yes or No If yes, provide brief explanation:

___________________________________________________________________________________

_ __________________________________________________________________________________

Level Enrolling For (please circle): (Level 1 & Level 2) (Level 3 & Level 4)

Other (Level 7; Certification), Continuing Ed

How did you hear about us: Newspaper Magazine Website Practitioner

Signed_______________________________ Date_________________________

Page 1 of 2 Pages

Friend Other (if so please explain) ____________________________

Any known medical conditions: ____________________________________________________________

______________________________________________________________________________________

**YOU ARE RESPONSIBLE FOR LETTING THE RESORT KNOW IF YOU HAVE ANY SPECIAL DIETARY NEEDS

TOOTHFAIRY EQD, INC and Center for NBD makes no claim or warranty that completion of any class or course will result in licenser or accreditation to practice equine dentistry in any state or region of the United States. State and/or local regulations and statutes differ substantially. You must determine state or local rules prior to practicing natural balance dentistry at a specific location.

(Level 5 & Level 6)

Center for Natural Balance Horse Dentistry

P O L I C I E S

Please read, sign and date:

Tuition is $1,865 for each week of class. To properly insure your experience is the best we can provide, class space must be reserved eight weeks prior to the first day of class. This enables us to assemble a teaching staff that can meet the varied needs of multiple levels of students.

If you register after the two month cut off, there is a late registration fee of $250 which is in addition to the tuition of $1,865. A deposit of 50% ($1,865 or one week) of the tuition is required two months prior to class to hold the student’s

space and must be accompanied by a signed registration form. Deposits are nonrefundable. In the case of a cancellation, the deposit ($1,865) can be transferred over to a

future class for a period of 2 years from the date of cancellation . If we have notification of cancellation 30 days or less prior to start of class a cancellation fee of 50% of deposit or ($932) will be charged. Final full payment and homework is due one month prior to the first day of class. Failure to submit homework could

affect your passing that particular Level In the case of a medical emergency that is proven by documentation prior to the start of class we will refund 50% of

the tuition ($1,865) if the tuition has been paid in full, and retain the deposit of $1,865 which can be used towards a future class within two years of the date of cancellation.* Continuing education is required every two years for Certified students, but recommended every eighteen months Cost of Continuing education/Certification Level 7 for Certified students will be $1,150/$1,49250% is due two months in advance of class. Cancellation Policy applies as above. Those students who, prior to Certification, do not continue their studies with Advanced Whole

Horse Dentistry Learning Center for a period of one year will experience the following:

Being dropped from the Student ListNetworking revokedWill no longer be able to state that “I study with Natural Balance Horse Dentistry”All other students will be appraised of the loss of privileges and that you are no longer a part of the student body. This suspension of privileges will remain in effect until the student has contacted and returned to NBD school.

In regards to referrals, referrals will go to Certified students, in the case that there is no one available to cover an area, we will work our way down through Level 7,6,5 and 4. Level 4 will be

Signed_______________________________ Date_________________________

Revised: 11/2018

Page 2 of 2 Pages

the lowest referral. (Level 4 by instructor approval.) Documentation of 50 hours study about the paradigm at your current level must be submitted one month prior to class Head and Neck Anatomy must be studied from The Atlas Of Equine Anatomy, by C. Pasquini, V. K. Reddy, and M Ratzlaff, and students WILL BE TESTED. The on-line course "EQ-50": Equine Anatomy Precourse Distance Study. This course MUST be completed with a passing grade and certificate prior to certification and recommended to be taken within one year of Level 1 for the students benefit. (Veterinarians & Vet Techs are exempt.)

Students understand that Center for Natural Balance Horse Dentistry may display and use any photographs taken for advertising, display, website and Internet promotions.