STUDENT PART-TIME ENROLMENT FORM [FILLED BY PARENT]

STUDENT ENROLMENT FORM [PT]

Please fill the form out carefully. By the students parent or guardian.
Name :*

Students First NameStudents Last Name
Birth Date :*

MonthDayYear
Date
Gender :*
ID Number or Passport Number :*
Nationality :*

South African.Not South African.A Permanent Resident in South Africa.
Home Language(s) :*
Permanent Home Address :*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Address :*
example@example.com
Phone Number :*
Please enter a valid phone number.
Emergency Contacts Name :*

First NameLast Name
Emergency Contacts Cell Number :*
Please enter a valid phone number.

MEDICAL & EMERGENCY INFORMATION
Do you suffer from any medical conditions or disabilities that may affect your learning ability ?*

YESNO
Please specify if you chose YES :
Membership Number :
Medical Aid Name :
Family Doctors Name :
Doctors Telephone Number :
Please enter a valid phone number.
MEDICAL CONSENT

I, the undersigned guardian, hereby give consent for the Director of the college, or their appointed representatives, to act on my behalf in the event that medical treatment or surgical intervention is deemed necessary during the students participation in college-related activities.To the best of my knowledge, the above mentioned student is in good health and physically capable of participating in all scheduled activities. I confirm that all relevant medical information have been truthfully and accurately provided in the form above.
Your Signature :*

Powered by Jotform SignClear
Medical Consent and Program Liability Waiver : I, the parent/guardian of the above student, confirm that the above mentioned student is fully aware of the nature of the program for which i am registering for at the DJ Academy. I understand that this program involves physical activities and hands-on participation in an immersive music and DJ training environment. Activities may take place in both indoor and outdoor settings and could include prolonged standing, use of electrical equipment, sound systems, and exposure to high-volume music. I acknowledge that there are inherent risks associated with these activities. As a condition of above mentioned students participation in this program and/or use of DJ Academy facilities and equipment, I agree to take full responsibility for any personal injury, property damage, loss of personal property, or any other loss that may occur as a result of their participation. Furthermore, I agree not to hold the DJ Academy, its directors, staff, agents, or representatives liable for any damages, liabilities, or expenses that may arise from their involvement, to the fullest extent permitted by law. I confirm that they are in good health and physically capable of engaging in the activities required by the program. All relevant medical information has been truthfully provided in the form above.*

I ACCEPT THE TERMS AND CONDITIONS

Registration Payment :

Please make your non-refundable registration payment of R 400 using the bank details below and email your proof of payment to dj@mmma.co.za | REFERENCE : DJ {your name}
Your Signature :*

Powered by Jotform SignClear
Date :*

MonthDayYear
Date Signed
TERMS & CONDITIONS

N.B. Please make sure you fill in your details on the Terms & Conditions form and sign it.
Should be Empty:

STUDENT ENROLMENT FORM [PT]

MEDICAL & EMERGENCY INFORMATION

MEDICAL CONSENT

PART-TIME COURSE DETAILS

Registration Payment :

TERMS & CONDITIONS