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First Aid Course Registration of Interest Form

If you are registering within five (5) business days of the course date, do not use this form. Please phone our office directly to make a booking. (08) 9759 1499 Tuesday – Thursday 9.00am-3.00pm.
Use the following form to select and register your interest to attend one of our courses. Please make sure you carefully check the course and date/time you select. This registration is not a confirmed booking. We will be in touch to confirm your attendance and arrange payment for your course.
Unique Student (USI) Number

Please type your Unique Student (USI) Number if you already have one.

Title (*)
Please tell us which class you wish to attend.

First Name(*)
Please type your first name.

Last Name(*)
Please type your last name.

Date Of Birth(*)
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Address(*)
Please type your address

Suburb(*)
Please type your Suburb.

Postcode(*)
Please type your postcode

Phone Number(*)
Please type your phone number

Please enter your phone number and area code. ie 08 234 5678

MobileNumber(*)
Please type your phone number

Please enter your mobile phone number. ie 0408 234 567

E-mail(*)
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E-mail Confirm(*)
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Select Course (*)
Please tell us which class you wish to attend.

HLTAID001 Provide CPR: Select Date of Course(*)
Please tell us which class you wish to attend.

HLTAID001 Refresher: Select Date of Course(*)
Please tell us which class you wish to attend.

HLTAID003: Provide first aid: Select Date of Course(*)
Please tell us which class you wish to attend.

Family Resuscitation Awareness: Select Date of Course(*)
Please tell us which class you wish to attend.

First Aid Awareness for Seniors: Select Date of Course(*)
Please tell us which class you wish to attend.

Billing information - Payee(*)
Please enter the payee details

Preferred Payment Method - Payment form will be emailed(*)
Please tell us which payment method you intend to use

Concession(*)
Please specify any concession

Discount Voucher

Please complete this section so we can validate your Unique Student Number (USI) to record the outcomes of your course. Please enter the responses you provided to create your USI.
LANGUAGE & CULTURAL DIVERSITY
In which country were you born?
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Indigenous Status
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Do you mainly speak English?
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If no, which language do you mainly speak?
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How well do you speak English?
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DISABILITY
Do you consider yourself to have any disability (Impairment or long-term condition)
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If yes, specify:
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EDUCATION
Are you still attending secondary school?
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Highest school level completed?
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Year completed school?
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Have you SUCCESSFULLY completed any of the following qualifications?
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EMPLOYMENT STATUS
What is your employment status?
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REASON FOR STUDY
Which option best suits your reason for study?
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CONSENT
I give permission to St John Ambulance Western Australia Ltd. To share my training outcomes with any employer.(*)
Please indicate

TERMS & CONDITIONS OF ENROLMENT
Please read the following Terms & Conditions of Enrolment and acknowledge acceptance below.
Course Attendance: (1) Please arrive 15 minutes prior to course commencement for registration. (2) Please note all students are required to present photo identification prior to commencement of the course. (3) Please ensure that you wear comfortable clothing as you will be required to demonstrate practical skills learnt. We recommend shorts or pants and closed in shoes.
Course Transfer Policy: (1) If you are unable to attend due to illness or injury a medical certificate will be required to transfer your booking at no cost. (2) No fee will apply where a minimum of 10 business day’s written notice is given prior to the course date. (3) A fee of 25% of the course cost will apply where between 5 and 9 Business days written notice is given to the course date. (4) A fee of 100% of the course cost will apply where less than 5 Business days written notice is given to the course date.
Course Cancellation Policy: (1) A full refund will be given where a minimum of 10 business day’s written notice is given prior to the course date. (2) A 75% refund will apply where between 5 and 9 Business days written notice is given to the course date. (3) No refund will be given where less than 5 Business days written notice is given to the course date. (4) A substitute participant may attend a course at no extra charge provided that we receive written notice prior to the course date and the substitute student has completed any required pre-learning and/or course pre-requisites.
Please acknowledge the Terms and Conditions of Enrolment(*)
Please acknowledge

FIRST AID COURSES

HLTAID003 Provide first aid - 1 day
Thu Dec 13 @ 8:30AM - 04:30PM
HLTAID001 Provide CPR
Thu Dec 13 @ 8:30AM - 12:00PM