Student Registration Form

Further Contact Details
Permanent Home Address*

Street Address

Street Address Line 2

Town/CityState

Post CodeCountry
Is your postal address the same as above?*

YesNo
Postal Address*

Postal Address

Postal Address Line 2

Town/CityState

Post CodeCountry
Emergency Contact*

First NameLast Name
Emergency Contact Relationship to You*

Nominated ContactParent/GuardianPartner/Spouse
Emergency Contact Phone Number*
Please enter a valid phone number. If a landline, please include your area code.
Emergency Contact Email*
example@example.com.au

Parent/Guardian Details
Parent/Guardian Name*

First NameLast Name
Are your Parent/Guardian's address details the same as yours?*

YesNo
Parent/Guardian Address*

Street Address

Street Address Line 2

Town/CityState

Post Code
Is your Parent/Guardian's phone number the same as yours?*

YesNo
Parent/Guardian Phone Number*
Please enter a valid phone number. If a landine, please include your area code.
Is your Parent/Guardian's email address the same as yours?*

YesNo
Parent/Guardian Email*
example@example.com.au

Declaration and Consent
Do you allow North Regional TAFE to reproduce, publish or broadcast your image or voice in any of the media outlined in the Copyright Act?*

YesNo
By signing:

I declare that all personal information I have provided is true and correct to the best of my knowledge;

I have read and agree to all of NRT's Enrolment Terms & Conditions;

I read and agree to NRT's student-related Policies & Procedures within the Student Handbook;

I have read and understand the information about the course I am currently applying for, as provided on North Regional TAFE's website.
Signature*

Clear
Name*

First NameLast Name
Date*

DayMonthYear
Is your Parent/Guardian present to consent and sign this registration form?*

YesNo
Parent/Guardian Consent to be followed up*
Parent/Guardian Consent*
Parent/Guardian Signature*

Clear
Parent/Guardian Name

First NameLast Name
Date

DayMonthYear
Cert Level Convert to SP
Campus convert to SP
Should be Empty: