Complete the enrolment form and click on "Submit Enrolment"

Enrolment Form

Please complete all fields marked with *

Personal Details

Title*:	Mr. Mrs. Ms. Dr.
First Name*:	Last Name*:
Postal Address*:
E-mail address*:	Sex*: Male Female
Date of Birth (DD/MM/YYYY)*:	Age*:
Phone number (Home/Work)*:	Phone number (Mobile)*:
Drivers Licence No.(or other)*:
Medical Details
Medicare Number*:	Ambulance Cover*: Yes No

Medical condition/Learning Disability*: Yes No	If yes (please specify):

Next to Kin Details (Student below 18 - Parent/Guardian details)

Full Name*:	Relationship*:
Address*:
Phone number (Home/Work)*:	Phone number (Mobile)*:
Course Details
Enrolment for*:
Mode of study* :	Full Time Part Time External

Experience

Have you worked in the related Industry? Yes No

If yes (please specify):

Person Responsible for Payment of Fees

Full Name*:	Relationship*:
Address*:
Phone number*:
Other Comments
Enter any other information regarding your enrolment:

Terms and Conditions

Click Here for the Terms and Conditions page

I declare (person over 18 years or Guardian) that I have read, understand and agreed with all Terms and Conditions listed here and that the statements are to be true in all aspects. Agree Disagree

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