Student Enrolment Form
You are enrolling in a Health and Safety Representative (HSR)
Course Start date: 13 Jan 2025
Please fill in the Registration form below. Fields with a red * are required.
I have read and I agree to the Perth Training Institute Privacy Notice *
Enter your full name
Enter your birth date
As the student being enrolled is a minor, I the Parent/Guardian acknowledge the privacy policy, of Perth Training Institute written out on section one(1) of this enrolment form and consent to these policies & conditions. *
Please select your Gender
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.
Your Company of employment
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
Language, Literacy & Numeracy
How did you hear about us?
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?