SHCC Membership Registration Form

SHCC Membership Registration Details

Please fill in the sections below so your Membership ID can be processed.
Name*
First Name
Last Name
Gender*
Date of Birth*

DayMonthYear
Please enter you date of birth
Home Phone Number
Please enter a valid phone number.
Work Phone Number
Please enter a valid phone number.
E-mail*
example@example.com
Address*

Please enter the House number and Street name

Street Address Line 2

CityPlease state the district where you live

Zip Code
Are you a Resident in St Helena (Y/N)*
Do you have St Helena Status (Y/N)*
Employer/Employment Status*
Job Title
Computer Literate
Learning Support Needs
Criminal Conviction (Y/N)*
Please note: If you have a previously criminal conviction, your application will be subject to approval.
Your Personal Information:

We Recongnise that your privacy is important to you.

Your information will be kept securely and will be not be disclosed to third parties without your permission, unless we are required or permitted by any other Court order.

Applicants Declaration:

I wish to be considered for Membership of the St Helena Community College.

If admitted I agree to comply with the College policies and/or Code of conduct. I also agree to SHCC processing my personal data contained within this form or other data, which SHCC may obtain from me or others for any purpose connected with my course application, my studies, my health and safety, or for any other legitimate reason.

If I have not obtained the age of 18 years, I agree that SHCC may contact my parents(s), guardian, or carer to discuss this application.
Please tick to agreed the above terms*

I AgreeI do not Agree
Should be Empty:

SHCC Membership Registration Details