Booking2

The information collected in this booking/enrolment form is required as part of the College's obligations as a training company. We'd also like to draw your attention to our terms and conditions.

COVID-19 Declaration

In the interests of public health and safety we respectively ask you not to attend training with us if you have any cold, flu or COVID 19 symptoms. If you are feeling unwell on the day of your course please call us. You will be able to postpone attendance to any future course date.

I declare that I will comply with this request
I do not wish to comply with this request

*Title: Mr Mrs Ms Miss

*Given names:

*Surname:

*Date of Birth:

*Country of Birth:

*Gender: Male Female

Contact Details

If possible, please provide us with both a home (landline) number and a mobile number as most of our courses have practical sessions within them and it may become important for our trainers to contact you.

Telephone:

*Mobile:

Driver Licence Number:

Emergency Contact Details

*Name:

*Relationship:

Address Details

Please provide the physical address (street number and name, not post office box) where you usually reside. If you are from a rural area use the address from your state or territory rural property addressing or numbering system as your residential street. This is the address your qualification will be sent to.

Building/Property Name:

Flat/Unit Number:

*Street/Lot No:

*Street Name:

*Suburb, Locality or Town:

*State/Territory:

*Post Code:

Language and Cultural Diversity

*What is your citizenship status?:

*Do you speak another language other than English at home? Yes No, English only

*How well do you speak English?

*Do you consider yourself to have a disability, impairment or medical condition which may impact on your ability to complete the training? Yes No

*You may indicate more than one area. This will not prevent you from enrolling in the course. Contact the College if you have any concerns. Hearing/deaf
Physical
Intellectual
Learning
Mental illness
Acquired brain impairment
Vision
Medical condition (diabetes, asthma, epilepsy, blood pressure, heart, fainting, dizzy spells, back/joint)
Other

*If other, please specify:

Do you have any maritime commercial or recreational qualifications? (Please specify):

*Is there anything related to your learning you would like assistance with? Yes No

*Would you like to do a short evaluation of your language, literacy and numeracy (LLN) skills before starting the course? Yes No

*Would you like further information about Recognition of Prior Learning/Credit Transfer for this course? Yes No

Student Declaration:

I understand that if I have ticked any item in the medical disclosure section that it will not necessarily prevent me from enrolling in the course and that if I have concerns relating to my health, wellbeing and ability to complete the training I can have a confidential discussion with a course advisor about them. This information is used by us only to process your enrolment and for attending to your safety while you are on the course.

I understand that associated practical activities may have risks associated with them and whilst it is not possible to eliminate all risks, appropriate controls have been implemented to promote the health, safety and welfare of all College students, staff and visitors.

I agree to abide by NMC policies, code of conduct, course conditions, conditions for accessing NMC property and materials and declare to the best of my knowledge the information given in this enrolment/booking form is complete and true and that I am aware of the consequences that may arise from providing false, misleading or incomplete information, including the cancellation of my enrolment or the withdrawal of any offer made by the NMC.

*I agree to all the above conditions. If unticked, the enrolment will not be accepted.

Media Consent - I grant the National Maritime College permission to take photographs or video of myself during any classroom/ practical sessions and permit NMC to use any such images for promotional or teaching purposes. Yes No

To show you are a person filling in this form rather than a spamming script, what day of the week comes after Sunday

National Maritime College

National Maritime College

Enrolment Form

COVID-19 Declaration

Personal Details

Contact Details

Emergency Contact Details

Address Details

Language and Cultural Diversity

Medical Disclosure

Boating Experience

Student Declaration: