Short Courses Application Form and Contract of Enrolment
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Short Courses Application Form and Contract of Enrolment Contact details Phone +27 63 303 2270 Email address [email protected] Website www.etacollege.com Preferred region to attend the short course Region Address Tick Bloemfontein Ramblers Sports Club, 40 Alexandra Avenue, Bloemfontein Cape Town WPCC, Ave de Mist, Rondebosch, 7700 Human Performance Institute, Isaiah Ntshangase Rd, Moses Durban Mabhida Stadium, Durban. East London Hamilton Sports Club, 1 Cleverdon Road, East London George C J Langenhoven St, Eco Stop Centre, Block B, George, 6529 Johannesburg Randburg Sports Complex, Malibongwe Drive, Randburg Mbombela Stadium Nelspruit 1 Bafana Road, Mataffin, Nelspruit, 1200 Port Elizabeth 69 Pickering Street, Newton Park, Port Elizabeth Pretoria Supersport Park, 1st Floor West Block Private Suites, Centurion Stellenbosch House 19 Herold St, Stellenbosch 7600 Banking details Account holder Exercise Teachers Academy (Pty) Ltd Bank Nedbank Limited Branch Name Southern Peninsula Account number 1191103080 Branch code 12 32 09 Universal code for EFTs: 19 87 65 Type of account Current Account Instructions to the eta applicant: 1. Please read the Terms and Conditions of Registration and accept before you complete the form. 2. Each box below is essential information so please complete the entire form. 3. All assessment criteria must be achieved before certification is considered. 4. NB: If you are 18-years or over, please ensure that the ‘Acknowledgement and Declaration’ is signed. 5. The fees for the chosen course must accompany this application form. 6. NB: A certified copy of the ID document of the applicant as well as the person responsible for the payment of the course fees should be attached to the application. 7. Include proof of admission documents such as industry qualifications proving knowledge of anatomy and physiology components. (if applicable) 8. Confirmation: Once all required documentation (http://www.etacollege.com/application- rules/) is received, approved and the required course fees have been paid, successful applicants will receive a notice of registration and confirmation of enrolment. Exercise Teachers Academy PTY Limited 1 1. Please read the Terms and Conditions of Registration attached to this form carefully. 2. All details sought in this document must be completed accurately, truthfully and correctly. Omissions, falsities or inaccuracies may result in a delay in the processing of your application and / or harm being suffered by eta occasioned by the reliance on such incomplete or inaccurate information. In completing this document and making application as set out herein, you specifically agree to indemnify and hold eta harmless against any harm, damage or loss which may be brought about or occasioned as a result of eta relying on any false, inaccurate or incomplete information. In addition, you warrant that the information is true, complete and accurate. 3. The eta Admission Criteria (a copy of which can be found on our website at http://www.etacollege.com/admission-criteria/) should be read carefully to ensure that you qualify for admission for the course of choice. In completing this document and making application as set out herein, you specifically warrant that you have read, understood and comply with the admission criteria as set out in this document. For more information on specific course admission, visit http://www.etacollege.com/admission- criteria/ 1. Short course choice (Select one course from the table below. Check the course information sheet before making your choice.) CATHSEETA SHORT COURSES Admission: no minimum requirement Exemption: Current eta fitness, coaching science students, graduates or applicants with a similar qualification may receive exemption for one module in the courses below. Please submit proof of current and/or past studies. Course date Short Course Deposit Total Fee Tick choice scheduled Fitness Instructor R2250 R7500 Group Exercise Instructor R1500 R5000 Group Exercise Instructor: Indoor Cycling R1500 R5000 Group Exercise Instructor: Pilates R1500 R5000 Group Exercise Instructor: Yoga R1500 R5000 REPSSA ENDORSED SHORT COURSES Admission: Qualified prospects with a qualification equivalent or similar to NQF Level 4 Certificate: Fitness, Group exercise instructor, Pilates Instructor Exception: Sport Massage (Anyone may apply) Course date Short Course Deposit Total Fee Tick choice scheduled Sport Massage R2100 R7000 Course date Short Course Total Fee Tick choice scheduled Kettlebell Training R3000 Combat Training R3000 Speed and Agility for Sport R3000 Olympic Lifting R3000 Primal Movement R2000 Suspension Training R2000 Initial: ___________ Exercise Teachers Academy PTY Limited 2 2. Applicant personal details (Please complete in full.) Passport No South African ID or No Alternate ID No Date of Initials Title Birth Surname First Name Gender Male Female if available optional Second Name Nick Name Population Nationality Group Dual (SA plus Citizenship South Africa Permanent Resident Other other) Single (never Marital Status Married Separated Widowed Divorced married) Socio-economic Employed Unemployed Scholar/Student Pensioner/retired Status How did you Home Language hear about eta? Do you have a disability, special health condition or special need that we need to know about? Yes No Please attach relevant details The information is required by the Department of Higher Education and Training. The eta does not discriminate against any person based on religion, race or gender. 3. Applicant contact details (Please complete in full) Preferred method of Cell Email Mail SMS communication If you do not have an email, you will be required to create one. We recommend creating a free Gmail account. Email Address Physical address Line 1 Physical address Line 2 Postal Country Code Postal address Line 1 Postal address Line 2 Postal Country Code Contact Numbers Home: Cell: Work: Fax: 4. Tertiary application details (Please circle your answer) Were you previously enrolled at any tertiary institution? Yes No Were you previously enrolled at eta College? Yes No Are you the first member in your family to enrol at a tertiary Yes institution? No Initial: ___________ Exercise Teachers Academy PTY Limited 3 5. School and education details (Please complete in full) Name of last school attended Highest standard completed Province/city where this school is located NB Documents: (if applicable) a) Attach a certified copy of your NSC (National Senior Certificate), GCSE (General Certificate of Secondary Education) or similar certificate. If these are not yet available, midterm results or grade 11 results may be submitted in the interim. b) Attach certified copies of other qualifications that you hold. 6. Additional contact details (Please provide us with an additional contact in case of an emergency) Please indicate nature of relationship to Father Mother Guardian Sponsor Other applicant First Title Surname Name Email Address Contact Home: Cell: Numbers Work: Fax: Payment of fees 30% Non-Refundable deposit require on registering remainder before course starts. Remainder of the fees to be paid in full before course date Who will be responsible for the payment of tuition fees? METHOD OF PAYMENT (tick option) Upfront EFT Credit Card Acknowledgement and declaration of application To be completed by the applicant if 18-years or over and by the parent/legal guardian if applicant is under 18-years of age 1. Applicant: I have read and understood the eta Terms and Conditions of registration and confirm that I am bound thereby. I declare that the information that I have supplied herein to be complete and true. I understand that if any of it this information found to be incomplete, false or misleading, eta has the right to dismiss my application. In addition, I agree to indemnify and hold eta harmless against any harm, damage or loss which may be brought about or occasioned as a result of eta relying on any false, inaccurate or incomplete information. Signature of applicant Signed at Date Parent/legal guardian: I confirm that I am the parent/guardian of the applicant above. I hereby give my consent to the applicant applying for registration. I have read and understood the eta Terms and Conditions of registration and confirm that I am bound thereby. Signature of parent/legal guardian Signed at Date Initial: ___________ Exercise Teachers Academy PTY Limited 4 TERMS AND CONDITIONS OF REGISTRATION AGREED UPON BETWEEN The Exercise Teachers Academy (Pty) Ltd Registration No. 2005/021935/07 (eta) AND The Applicant (“Terms and Conditions”) Note: These Terms and Conditions must be read with and form an integral part of the eta Application Form to which they are attached. 1. INTERPRETATION 1.1 In these Terms and Conditions, unless the context clearly indicates a contrary intention: - 1.1.1 Any gender shall include the other genders. 1.1.2 A natural person includes an artificial person and vice versa. 1.1.3 The singular includes the plural and vice versa. 1.2 The following terms shall have the meanings assigned to them hereunder and cognate expressions shall have a corresponding meaning unless inconsistent or otherwise indicated by the context: 1.2.1 “Applicant” / “You” or “Yourself” means the person whose particulars appear as such in the Application Form; 1.2.2 “Application Form” means the application to which these terms and conditions are attached; 1.2.3 “Course Fees Schedule” means eta’s applicable Course Fee Schedule (a copy of which can be found on our website https://www.etacollege.com/admissions/fees/)and