First Aid Enrolment Form

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First Aid/CPR Enrolment Form

HLTAID001 Perform Cardiopulmonary Resuscitation + HLTAID003 Provide First Aid

Enrolment – Step 1 of 2

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Student Participant Handbook

Before you complete our online enrolment form, please read the above Student Participant Handbook.

Course I would like to enrol into:*
Select First Aid date*
- 9 March 2021
- 15 April 2021
- 8 July 2021
- To be confirmed
Name*
First Last
Date of Birth*
Date Format: DD slash MM slash YYYY
Phone*
Email*
Preferred method of contact?*
- Phone (during business hours)
- Phone (outside business hours)
- SMS
- Email
Do you have any disabilities that may impact your ability to study?*
- Yes
- No
If yes - please download medical clearance from here download medical clearance. Please fully complete THIS FORM and have it signed by a Doctor and emailed to info@h-p-c.com.au PRIOR to course commencement.
If yes, please provide details below:
Do you have any medical conditions or injuries that may impact you from participating in exercise?*
- Yes
- No
If yes - please download medical clearance from here download medical clearance. Please fully complete THIS FORM and have it signed by a Doctor and emailed to info@h-p-c.com.au PRIOR to course commencement.
If yes, please provide details below:
Are you pregnant?*
- Yes
- No
If yes - please download medical clearance from here download medical clearance. Please fully complete THIS FORM and have it signed by a Doctor and emailed to info@h-p-c.com.au PRIOR to course commencement.
Gender*
- Male
- Female
Emergency / Next of Kin Contact
First Person
Name*
First Last
Phone*
Relationship to you*
Second Contact Person
Name*
First Last
Phone*
Relationship to you*
Your Residential Address*
Street Address Suburb State Postcode Country
ID File Uploader (10MB Limit) Page 1 (ID is required for student record identity purposes)*
ID File Uploader (10MB Limit) Page 2 (optional)
Are you of Aboriginal or Torres Strait Islander origin?*
- No
- Yes - Aboriginal
- Yes - Torres Strait Islander
Are you still attending secondary school?*
- Yes
- No
If yes, L.U.I. number
Is English your first language?*
- Yes
- No
Other language (please specify)
How well do you speak English?*
- Very Well
- Well
- Not Well
- Not At All
In which country were you born?*
- Australia
- Other
Other country (please specify)
What is your highest completed school level?*
- Year 12 or equivalent
- Year 11 or equivalent
- Year 10 or equivalent
- Year 9 or equivalent
- Year 8 or equivalent
- Never attended school
Which year did you complete that school level?*
Of the following categories, which best describes your current employment status?*
- Full-time Employee
- Part-time employee
- Employed – unpaid worker in a family business
- Self-employed – not employing others
- Unemployed – seeking part-time work
- Unemployed – seeking full-time work
- Not employed – not seeking employment
Of the following categories, which best describes your main reason for undertaking this course?*
- To get a job
- It was a requirement of my job
- To develop my existing business
- I wanted extra skills for my job
- To start my own business
- To try for a different career
- For personal interest or self-development
- To get a better job or promotion
Have you successfully completed any of the following qualifications? If YES, then tick ANY applicable boxes.
- Bachelor Degree or Higher Degree
- Advanced Diploma or Associate Degree Certificate II
- Certificate IV (or Advanced Certificate/Technician)
- Certificate III (or Trade Certificate)
- Diploma (Or Associate Diploma Certificate)
How did you hear about us?*
Are you an Australian resident?*
- Yes
- No
Do you have a current visa?
- Yes
- No
I am happy for Human Performance Centre to source my USI (Unique Student Identifier) on the Australian Government website should the need arise.*
- Yes
- No
Notes/Comments
I have read and understood the contents of the HPC student handbook*
- Yes
I have read and understood all Terms and Conditions associated with enrolment*
- Yes
Payment Method*

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