Booking Request

Use this form to send us your course booking, please ensure that you fill out the form correctly before sending your booking request.
If you would like to book a group please supply your details as the group representative, provide a group name and at least one other group member.

  • Course
    booking details
    Course : Selected
    Date : Selected
    People : Outstanding
    Amount : R 650
    Total : R 0
  • Step 1 - Your Course





    Step 2 - Your Date


    Your time
    08:15 - 14:00

    If none of the dates above suit you, please click here

    NB: Creating a custom date requires approval by Survival and a minimum of 8 individuals

    Your venue
    Petervale Child Therapy Center
    Your address
    31 Rembrandt Avenue Petervale/Bryanston Johannesburg

    Step 3 - Your Particulars



     


     

     

     


  • Course
    payment details

    Bank Details

    Bank:
    First National Bank
    Branch:
    Sandton City
    Code:
    254605
    Account:
    51320132916