Student Enrolment Form
You are enrolling in a WHS BLOCK 4 - Virtual Class
Course Start date: 17 Nov 2025
****Bookings for currently enrolled students ONLY.**** 9:00am - 4:00pm BLOCK 4 - Incident Response & Return to Work Implications 1. BSBWHS416 Contribute to workplace incident response 2. BSBWHS417 Assist with Managing WHS Implications of return to work 3. Assessment day OPTIONAL
Please choose your enrolment type, then fill in the form. Fields with a red * are required.
I have read and I agree to the Privacy Statement
I have read and I agree to the terms and conditions. *
Full Name
Date of Birth
As the student being enrolled is a minor, I the Parent/Guardian acknowledge the privacy policy, the terms and conditions, of Pivot Solutions Pty Ltd trading as Mine Training Australia and Pivot Institute written out on section one(1) of this enrolment form and consent to these policies & conditions. *
Gender, Identity, and Pronouns
Enter your contact details
This email address will be used as a CC email address on communications to you, please use this field to indicate if we need to CC another person / company in your communications.
Company / Organisation name
Please enter the details for your your next-of-kin / Emergency Contact
What is the address of your usual residence?
Please provide the physical address (street number and name not post office box) where you usually reside rather than any temporary address at which you reside for training, work or other purposes before returning to your home. If you are from a rural area use the address from your state or territory’s ‘rural property addressing’ or ‘numbering’ system as your residential street address. Building/property name is the official place name or common usage name for an address site, including the name of a building, Aboriginal community, homestead, building complex, agricultural property, park or unbounded address site.
What is your postal address (if different from above)?
I have a postal address that is different to the residential address provided
RTO Specific Questions
Language, Literacy & Numeracy
Upload an attachment
(To upload multiple files, please Zip the files together, and upload the Zip file)
Is there anything else we need to know, in regards to your enrolment?
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