International Programme for Applied Canine Studies (IPACS) – Application Form 2015
Please complete and return to: Sheila Harper Ltd, The Winding House, Walkers Rise, Hednesford, Staffs, WS12 0QU
Tel: +44 (0)1543 878989 email: info@sheilaharper.co.uk
web site: www.sheilaharper.co.uk
PERSONAL DETAILS (Please print)
Title: Mr/Mrs/Miss/Other
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DATE OF BIRTH (DD/MM/YY)
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Full name ……………………………………………………………………………………….……………......
Address
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TOWN ……………………………………………… COUNTY ………………………………………………..
COUNTRY
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POST CODE
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TELEPHONE (day)………………………………. (eve)……………………….. (mobile)………………..….
EMAIL ADDRESS ………………………………..……………………………………………………………
NATIONALITY …………………………………..
OCCUPATION ………………………..………………….
EDUCATIONAL BACKGROUND
School/College ……………………………………………………………………………………………….....
Level of education achieved ………………………………………………………………………………....
Membership of professional bodies
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Special Needs: Please give details of any disability and/or medical condition which might require special arrangements, or facilities: …….………………………………………………………………..……..
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* I am bringing my own dog to work with / *I require a dog to be provided for me if possible *
Delete as appropriate
If you are bringing your own dog: Name of dog: ………………..……………………
Breed: …………………………………….. Age: …………………… Sex: ………… Neutered Y/N
We will ask you for more information relating to your dog(s) at a later stage
Please state any relevant considerations you feel we should be made aware of ………………………...
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Please complete the reverse of this form

EXPERIENCE WITH DOGS (Please include basic details only)
Breed specialities (if any) ……………………………………………………………………………………...
Problem specialities
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Field(s) in which the majority of experience has been gained ………………………………………….
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Training experience ……………………………………………………………………………………………
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Instructing experience (if any)………………………………………………………………………………...
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Behaviour experience
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Other courses currently being undertaken .........................................................................................
When do you expect to complete those courses?
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CANINE RELATED STRENGTHS / AREAS OF KNOWLEDGE (e.g. canine communication)
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Have you experience of dogs in any areas other than those stated above?
If so, please give brief details, including any voluntary work undertaken:
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State briefly your reasons for wishing to be considered for a place on this course:
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I enclose cheque for £ _______ made payable to ‘Sheila Harper Ltd’
I wish to pay by the following method (please tick box)
The full fee of £1899 + VAT in one payment (including discount of £100 for payment of the balance in full)
£500 to be paid by 31 st March 2015 followed by five monthly instalments of £310 and a sixth instalment of £350 payable by standing order ( total cost £2,000 + VAT) to start immediately your application has been approved.
Instalments are to start no later than April 15 (for a May course start date).
For payment of the full amount or booking fee, payment by cheque, debit or credit card or international bank transfer can be accepted. Please note that credit card payment incurs a 3% surcharge. Cheques should be made payable to “ Sheila Harper Ltd ”.
Students are required to bear the full charges for bank transfers.
Course fees are non-refundable unless notice of cancellation is given at least 14 days prior to the commencement of the course. If such notice is given then the whole fee will be refunded (less 20% for administration costs). If less than 14 days notice is given, or if a student has already taken advantage of benefits offered, such as a free place or related discount on our courses then no part of the fee will be refundable. For further information on terms including cancellation, please refer to the information accompanying the course outlines entitled Course Fees.
Signature………………………………………. Date (DD/MM/YY) ………|…………|…………..
The signing of this form implies that students accept the following conditions: Sheila Harper Ltd reserves the right to use and/or publish research and materials / video footage produced by students individually or collectively during this course. Credit will be given to students.