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Course Details
Course 1. Class name
*
Date
*
Course 2. Class name
*
Date
*
Personal Details
*
Indicates required field
Mr / Mrs / Miss / Ms
*
Name
*
First
Last
Gender
*
Male
Female
Other
Home Address
Street
*
Suburb
*
Postcode
*
Contact Details
Home Phone
*
Mobile
*
Work Phone
*
Email
*
Emergency Contact
Name
*
Relationship
*
Phone No.
*
Enrolments
Class fees are to be paid when enrolling. Places in classes are only confirmed upon payment of class fees.
Refunds
Refunds are available only up to 7 days prior to the commencement of classes. An
administration fee of $20 applies
to all refunds unless a Doctor’s certificate is provided, or a course is cancelled by WCLC. No credit is available for missed classes unless a medical certificate can be produced. Any credit will be applied toward the following term’s enrolment. See 7.2.1 Course/Activity Refunds Procedures.
Concessions
Concessions apply to
some
classes with the exception of Workshops. If you currently hold any of the following (please tick):
Choose Any
*
Centrelink Health Care
Veteran's Gold
Centrelink Pension/Concession
Seniors Card
Card No.
*
Expiry Date
*
Pension Type: (3 Letters at bottom of card)
*
To receive a concession on your class fee, your card needs to be sighted by Office staff.
Citizenship
Status
*
Citizen
Permanent Resident
Non-Resident
Indigenous Status
Are you of Aboriginal or Torres Strait Island origin?
*
Yes
No
Country & Date of Birth
Country of Birth
*
Date of Birth
*
Language
Main language spoken at home
*
English Only
Other
Please Specify
*
Spoken English Level
*
Very well
Well
Not well
Not at all
Important Information
The following information, policies and procedures must be given or explained prior to enrolment:
Enrolment procedures
Course information, including content and outcomes
Fees and refunds policies
Complaint Handling procedures
Code of Conduct
Participant Information
Privacy Statement
Copies of these documents are displayed on the noticeboard. I have been informed or given the above information and policies and agree to abide by them.
Signature
*
Date
*
Marketing
How did you hear about the Waverley Community Learning Centre?
*
Library
Brochure
Local Paper
Internet
Word of Mouth
Other
Would you like to be included on our email update listing?
*
Yes
No
Please Specify
*
Health Status / Support Required
Pre-Existing Medical Condition or Disability
Do you have a pre-existing medical condition, disability, impairment or long term condition that may affect your participation in class?
*
Yes
No
If YES, please complete the following (if NO please continue to the next question)
If YES, do you require reasonable adjustments or support to assist you to participate in the class?
*
Yes
No
If YES, Please advise what the Condition / Disability is and what adjustments or support you would require:
Condition/Disability
*
Adjustments/Support
*
This will need to be discussed with the Centre Manager.
*
Interview booked with Centre Manager
Interview with Centre Manager completed
Do you have a Management Plan?
*
Yes
No
Copy of Plan provided?
*
Yes
No
If you have a Medical Condition which may be impacted by your participation, it is advisable to obtain a Doctors Certificate stating that you have clearance to participate, as well as any suggestions for support or adjustments from your doctor.
Will you be providing a Doctor’s Certificate?
*
Yes
No
If you choose not to obtain a Doctors Certificate and participation in the class aggravates your condition, you agree that by signing this enrolment form that Waverley Community Learning Centre cannot be held liable.
Pre-exercise questionnaire. If you are participating in WCLC’s exercise classes and have a pre-existing medical condition which impacts on your attendance and have not obtained a doctors certificate, you will be asked to fill in a Pre-exercise questionnaire (for the Tutors information only) in addition to this enrolment.
Pre-exercise Form to be completed
*
Yes
No
Privacy
In accordance with The Privacy Act, it is the policy of the Waverley Community Learning Centre to maintain the highest level of confidentiality for information provided by it’s participants. Information collected, is either required by law or necessary for the running of the course you are enrolled in. The signing and handing in of this completed enrolment form signifies your approval to use your information for those purposes.
See the Privacy Statement on the noticeboard.
I agree that the information provided in this application for enrolment form is complete and accurate.
*
Yes
No
Signature
*
Date
*
For more information see the Centre’s Enrolment Policy on the noticeboard.
Submit
HOME
ABOUT
CLASSES & ACTIVITIES
PROGRAM GUIDE
ENROLMENT FORMS
ADULT CLASSES
CHILDREN CLASSES
EVENTS
ROOM HIRE
ACCESSIBILITY
VACANT POSITIONS
CONTACT
VACANT POSITIONS
