Community Education Enrolment Form

Community Education Enrolment Form

Fill out ALL spaces on the form carefully
Programme Name*
e.g. Te Reo for Beginners Turangi
Programme Location*
If this enrolment is for 'Supporting Our Kids'' please choose session below:

1.00pm5.30pm
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

City

Post Code
Phone Number*
E-mail*
example@example.com
Birth Date*

DayMonthYear
Gender*
Education*
Ethnicity*
Eligibility*
Proof of residency or citizenship required if not born in New Zealand (see below)
Identification required - REAP require your National Student Number (NSN) to complete your enrolment, please add below or leave blank and we will find it for you.
National Student Number
NOTE: If you are not born in New Zealand you are required to provide evidence of residency - please upload

Cancelof
Permission - I consent to any photos taken during this programme to be used on public forums such as Facebook, Newspaper, e-panui or the REAP Annual Report*

YesNo
Declaration:

Privacy - REAP Central Plateau collects and stores information from this form to comply with the requirements of the Tertiary Education Commission. In signing this enrolment form you authorise such disclosure on the understanding that the organisation will observe the general conditions governing the Declaration.

I declare that to the best of my knowledge all the information supplied on, and with, this enrolment form is true and complete, and I consent to the disclosure of personal information as described above.
Signature*

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Today's Date*

DayMonthYear
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