Course enrolment form

Course Name

Name

First Name

Last Name

Email Address

Phone

Address

Emergency Contact

Date of Birth

Gender

Male

Female

Are there any special needs or medical conditions we should be made aware of? Please provide details

Concession Type

Pension

Healthcare Card

None

Unique Student Identifier

Do you have a USI?

How did you find out about the course?

I give Yackandandah Community Centre the permission to use images captured of myself during the course in its own marketing and promotional material.

I agree to the above

Privacy Statement

Yackandandah Community Centre respects your right to information privacy.   The information we collect and keep on students is kept confidential in accordance with privacy laws.   It is used for our administrative and statistical purposes only and will only be disclosed to our funding bodies as required. Please call the centre manager for further information.

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