Student Registration Form - VETDSS - MidWest Region

Consent and Health Care Information Form (CF003F2)
Student Name

First NameLast Name
Date of Birth

DayMonthYear
Health Care Information

Information is treated confidentialy and provided to Central Regional TAFE (CRTAFE) staff as required, including those staff organising excursions, and employers of students attending industry placement.
Emergency Contact Person 1*

First NameLast Name
Phone Number*
Please enter a valid phone number. If a landline, please include the area code.
Email*
example@example.com.au
Emergency Contact 1 Relationship to You*

Parent/Guardian/Responsible AdultNominated Contact
Emergency Contact Person 2

First NameLast Name
Phone Number
Please enter a valid phone number. If a landline, please include the area code.
Email
example@example.com.au
Emergency Contact 2 Relationship to You

Parent/Guardian/Responsible AdultNominated Contact
Medical Conditions
Do you have any medical conditions that the staff at CRTAFE should be aware of that may impact your ability to undertake the course. For example, diabetes, severe allergy, pregnancy, physical impairment etc.*

YesNo
Please list your medical conditions below.
Student Signature Signature* Date Date*
IMPORTANT: Students are advised that should they have an accident whilst on campus and the attending CRTAFE First Aid Officer considers it necessary to call an ambulance, due to their injured on unconcious state, the student will be responsible for all costs associated with the calling of the ambulance.

Students, or where the student is under 18 years of age their parent / guardian / responsible adult, are required to inform CRTAFE of any medical information changes throughout the course of their enrolment.
Students Under 18 Years of Age Consent
Please identify your relationship to the student listed above:*

ParentGuardianResponsible adult
Parent/Guardian/Responsible Adult Name

First NameLast Name
As the parent / guardian / responsible adult of the above named student, I acknowledge thet the infomation I have provided is correct and I have read and understood the Information for Parents and Guardians and I consent to the above named student undertaking studies at CRTAFE.
Please note: If your child has a medical condition, please ensure you contact the Manager Student Services on 1800 672 700 to discuss the management of your child's medical condition.

In the event of an emergency every effort will be made by CRTAFE to contact you.
Parent/Guardian Signature Signature* Date Date*

Talent Release Form (MK002F1)
Central Regional TAFE and the Government of Western Australia seek your consent before using and disclosing images or recordings of you.*

I give permission for Central Regional TAFE and the Government of Western Australia to publish written and verbal quotes, photographs, video or audio in which I am depicted for the purposes of promotion and communication in a range of materials, including, but not limited to social media, websites, publications, press stories, banners, brochures and other promotional material.I do not give permission for Central Regional TAFE and the Government of Western Australia to publish written and verbal quotes, photographs, video or audio in which I am depicted.
Exclude name

Check box to exclude the use of your name
Student Name

First NameLast Name
Student Phone Number*
Please enter a valid phone number.
Student Email
example@example.com
Student Signature Signature* Date Date*
If aged under 18, then your parent or guardian must complete the section below.
Parent/Guardian/Responsible Adult Name

First NameLast Name
Parent/Guardian Phone Number
Please enter a valid phone number.
Parent/Guardian Email
example@example.com
Parent/Guardian Signature Signature* Date Date*
You can withdraw your consent by providing written notice to marketing@crtafe.wa.edu.au. Once withdrawn, no new publications will be released in which you are resonably identifiable.

Note: Staff must immediately notify any collaborating Government agencies if consent is withdrawn.

Other Supporting Documents
Please upload any other documents in support of your application here.

Eg: Your last school report, letter of application, permission form.
Cancelof
Declaration and Consent

Confirm that the information provided is true and correct and that you agree to our Terms & Conditions.
Student Declaration and Consent*
Student Name

First NameLast Name
Student Signature Signature* Date Date*
Parent/Guardian/Responsbile Adult of a Student Under 18 Years of Age
The learning and social environment at Central Regional TAFE is very different from secondary education.

As the parent/guardian/responsible adult of a CR TAFE student under 18 years of age, please read and consider the issues and differences outlined in our Information Concerning Students Under 18 Years of Age document.
Parent/Guardian/Responsible Adult Consent*
Parent/Guardian/Responsible Adult Name

First NameLast Name
Parent/Guardian Signature Signature* Date Date*
Should be Empty: