Please complete the enrolment form shown below to sign up for your course. PERSONAL DETAILSFirst NameMiddle NameLast NameAddress Line 1 (Not a PO Box)Address Line 2SuburbStatePostcodeDate of BirthMobile No.GenderEmail Emergency Contact - NameEmergency Contact - MobilePROGRAM DETAILS Certificate III in Fitness Certificate IV in Fitness Certificate III/IV in Fitness International Fitness Certificate International Personal Training Certificate International Master Trainer Certificate PAYMENT METHOD Upfront Student Loan – Credit Card Student Loan – Direct Debit Payment Amount - Upfront $Plus(no of Payments)Monthly Payments of $(If Applicable)Payment NotesPAYMENT INFORMATIONIf paying by credit card, please provide your details below.Name on Credit CardCredit Card No.Expiry DateCVC NumberSignatureIf paying by Direct Debit (for Student Loans ONLY), please provide your details below.Account NameBSBAccount No.Signature* Please note that student loans are administrated by FFA Pay Smart and incur a once of setup fee of $5.50 plus a small admin fee of $2.95 per debit. I understand that: A full refund, less a $500 administration fee, will be given to students who cancel/withdraw their enrolment in writing within the 7 (seven) day cooling off period of enrolment. In circumstances where a student has entered into a payment plan for payment of course fees and withdraws from the course after 6 months of the date of enrolment, the student will be liable for all payments due under the agreed payment plan. In cases where students are suffering from medical ailment and are able to provide adequate documentation of such, upon application in writing, the student’s enrolment may be suspended for a period of no more than 6 months. No refund of course fees apply and the student will still be liable for all payments due under the agreed payment plan (if applicable). I confirm that I have read and agree with the above cooling off period and that my course will be facilitated by the International Fitness Academy.SignatureDate Date Format: DD slash MM slash YYYY LEARNING SUPPORTYou are enrolling into a Certificate IV level course that will require knowledge and skills in the below areas. Please tick to acknowledge these requirements and indicate if you believe you may have difficulty with any of the below: Computer programs including word processing Writing business documents RECOGNITION OF PRIOR LEARNING AND DIRECT CREDITWill you be applying for: (Please tick) Recognition of Prior Learning (RPL) Direct credit from previously completed qualifications To apply for the above you must be able to provide certified copies of previously completed qualifications, Certificates or Statements of Attainment and you may be required to provide evidence of current knowledge through other documents.AVETMISSThe information below is used for AVETMISS (national VET) statistical purposes only.Employment status: (Please tick) Student Casual employment Part time employment Full time employment Employer Unemployed For Casual or Part-Time Employment please tell us how many hours per week you work on average:If you are Unemployed, please tell us how long you have been unemployed for:Indigenous status: (Please tick) Aboriginal Torres Strait Islander Both Aboriginal & Torres Strait Islander Neither Country of birth: Australia Other (Please Specify) Other Country of Birth (If Applicable)Highest completed school level & Year Completed(eg - Year 12 in 2013)Qualifications completed: Please tick Bachelor Degree or higher Advanced Diploma or Associate Degree Diploma (or Associate Diploma) Certificate IV Certificate III Other If you ticked any of the qualifications above please elaborate below:Please provide the Date of Completion & Qualification DetailsDo you consider yourself to have a disability, impairment or long-term condition?YesNoIf yes, please indicate against type in box: Hearing/Deaf Physical Intellectual Learning Mental Illness Acquired Brain Impairment Vision Medical Condition Other (Please state below) If Other please state:Please be aware that your personal information will be entered into our database for training and statistical purposes.