Client Application

Client Application

* Wave Academy is Now Accepting Applications for 2017 Enrollment. *

Wave Academy is now accepting applications for 2017 enrollment from military personnel and veterans diagnosed with PTS, their caregivers, and individuals with a terminal illness. Please complete this online application for review and a Wave Academy representative will follow up with you shortly. Do I qualify as a Care Giver or Terminal Patient?  Click Here.

Application 2017

Legal Name:





Gender:

Your Email: (required)

Your Phone Number: (required)

Home Address:







Current Mailing Address:







US Citizen:

Relationship Status:

Are You Currently Employed:

Are You Currently Enrolled in School:

Age:

Ethnicity:

Race:

Complete the areas that ONLY apply to you. No information you provide will be used in a discriminatory manner.

Military Status if you are a Veteran or Active Duty:

Are You a Care Giver: (please check one)

Which Military Conflict were You Apart of:

Branch of Service:

Do You Have Children:

Please List the Children's Ages If Applicable:

How Did You Hear About Wave Academy:

Caregiver For:

Low Income Verification:
Wave Academy provides access to free treatment and very low cost treatment
to those who qualify in the county of San Diego as "very low income" and "low income".
You will be required to show evidence by presenting your copy of last years (2015) IRS Income Tax form; total income before deductions.
Please bring this with you should you qualify for an intake interview,

Dependents:

I certify that all information submitted in this application process is factually true, and honestly presented, and that these documents will become the property of Wave Academy to which I am applying and will not be returned to me. I understand that I may be subject to immediate termination of services should the information I have certified be false.

I acknowledge that I have reviewed the application instructions for Wave Academy. I understand that all offers of services are conditional.

I understand that all information submitted in this application will not be returned to me or used for any other purpose or shared with any other agency. I further understand that all of my information will be kept confidential with my client file at Wave Academy and I may request a copy at any time.

It is the policy of the Wave Academy not to discriminate in its selection process because of an individual's race, color, religion, sex, national origin, height, weight, marital status, political belief, genetic information, sexual orientation, disability or handicap which does not impair an individual's ability to perform aquatic bodywork. The Wave Academy affords every student all the rights, privileges, opportunities and activities available to students at the academy and guarantees non-discriminatory administration of its educational policies, scholarship and loan awards, athletic and other school-related programs..