Course Registration Form
Complete the form with information needed for enrolment:
Student Name
*
First Name
Middle Name
Last Name
Previous Last Name
ID Number
*
Birth Date
*
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Equity
*
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African
Colourd
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Nationality
*
Home Language
*
Gender
*
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Male
Female
N/A
Citizenship
*
Please Select
Dual SA (Plus Other)
South African
Permanent Resident
Unknown
Temporary Resident
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Socioeconomic Status
*
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Employed
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Home Make
N/A Aged
Copy of CV
*
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Disability Status
*
Sight
Hearing
Communication (Talking, Listening)
Physical (Moving, Standing)
Intellectual (Difficulty Learning
Emotional (Behavioural or Psychological)
Multiple
None
Disabled but unspecified
Highest School Qualification
*
Please Select
Grade 1 - 12
Unknown
Matric
Senior Certificate
Grade 9 and above
Below Grade 9
Copy of Highest School Qualification
*
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Highest Tertiary Qualification
Copy of Certificates obtained
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Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Student E-mail
*
Confirmation Email
myname@example.com
Mobile Number
*
Next of Kin Contact
*
Next of Kin Name and Surname
*
Relationship to Next of Kin
*
Courses
*
Please Select
Hairdressing Level 2-4
Hairdressing Trade Test
Beauty Technology Level 4
Nail Technology Level 4
Food & Beverage
Accommodation Services
Assistant Chef
Table Attendant
Business Practice
Business Administration
Generic Management Level 4
Generic Management Level 5
First Aid Level 1
First Aid Level 2
First Aid Level 3
Bridal Styling
Basic Barbering
Relaxer Expert
Shampoo and Styling Technician
Braiding and Dreadlock Technician
Make Up
Massage
Nails
Eyelash and Eyebrow
Working at Heights
Facilitators
Assessors
Moderators
ID Document (Front)
*
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ID Document (Back)
*
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POPI Act Concent
*
Yes
No
Date of POPI Act Concent
*
-
Month
-
Day
Year
Date
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Indemnity Form
I the above mentioned student hereby declare that I shall not institute any claim of any nature whatsoever against Dei Gratia Training and Development Solutions or any employee of Dei Gratia Training and Development Solutions acting within his / her employment capacity , nor shall I in any way whatsoever hold Dei Gratia Training and Development Solutions responsible for any loss or damages that I (the learner) may suffer in person or in respect of any property of mine (the learner), or which may directly or indirectly arise from my (the learner's) commitments as a registered learner towards Dei Gratia Training and Development Solutions. I furthermore authorise Dei Gratia Training and Development Solutions to act on my behalf, should I (the learner) be injured and cannot personally give consent to any essential medical treatment or intervention, to sign the necessary letter of consent. I wish to bring the following to your attention, however (state any allergies the learner suffers from or chronic conditions or medication)
List Allergies
List Medication
List Chronic Conditions
Medical Aid Fund
Medical Aid Option
Medical Aid Number
Main Member
Dependent Code
I Declare that the above mentioned Information is Correct
Yes
No
Signed on this day:
*
-
Month
-
Day
Year
Date
Signature
*
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Choose the courses you are interested in.
Hairdressing Full Qualification 18 Months
Beauty Full Qualification 18 Months
Hairdressing Skills (Short) Courses
Beauty Skills (Short) Courses
Barbering Skills (Short) Course
Facilitator, Assessor and Moderators Courses
Hospitality Courses
First Aid Level 1, 2 and 3 Courses
Home-base Care Courses
Early Childhood Development ECD
OHS in the workplace
Fire Fighting
Dance Instructors Full Qualifications 12 Months
Other
The quotation for the above selected courses will be sent to (Preferred Email):
*
example@example.com
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Signed on this day:
*
-
Month
-
Day
Year
Date
Signed by:
*
First Name
Last Name
Signature
*
Submit Application
Submit Application
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