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.



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Student details

Enter your full name







Enter your birth date






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

Address(es)

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

Misc.

Language, Literacy & Numeracy


  I require Language, Literacy and Numeracy assistance.



How did you hear about us?




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Is there anything else we need to know, in regards to your enrolment?

Payment

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