Enrolment In: BABY AND ME COURSE – FIRST AID FOR PARENTS & GUARDIANS – Romsey – Monday 22nd November 2021 2021 ENROLMENT FORM Step 1 of 5 - SELECT YOUR COURSE & ENROLMENT OPTIONS 0% Enrolment Form for NON-VET Accredited Courses EMAIL: ENROLMENT@ITS.EDU.AU | CALL: 1300 585 866 | WEB: WWW.ITS.EDU.AUSECTION A SELECT YOUR COURSE AND ENROLMENT OPTIONSBaby and Me First Aid Course for Parents and Guardians*Please note, children under 14 years of age are free to attend, learn and participate. Anybody over the age of 14 in attendance will be classified as a full enrolment. Price: How many children under the age of 14 will join you on this course?PLEASE NOTE: Children under the age of 14 are FREE to attend this course with you. Price: $ 0.00 Quantity: ESTIMATED ENROLMENT FEE $ 0.00 PLEASE NOTE: The final enrolment fee will be calculated at the end of this form after selecting your preferred payment method. SECTION B PERSONAL DETAILSName Dr.MissMr.Mrs.Ms.Prof.Rev. Prefix First Middle Last Date of birth* DD slash MM slash YYYY Select your date of birth using the calendar to avoid formatting errorsCONTACT DETAILSIf possible, PLEASE provide us with BOTH your home (landline) and mobile numbers. As this course requires the coordination of yourself and our trainers, it may become important for our team to contact you should the need arise. Telephone: HomeTelephone: Mobile*Your preferred email address* Enter Email Confirm Email RESIDENTIAL ADDRESS Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Please provide the physical address of where you usually reside - street number and name, not post office box. Do not provide any temporary address at which you reside for training, work or other purposes. If you are from a rural area, use the address from your state or territory's rural addressing or numbering system as your residential street. MAILING ADDRESSIs your mailing address the same as your residential address?* YES NO Please enter your mailing address below. Please enter your mailing address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country NOTE: This will be the address our team will send out your Certificate should you choose to have a printed copy sent to you SECTION C EMERGENCY CONTACT DETAILSThis course requires participants to practice and perform CPR on a child and baby manikin alongside other practical elements of first aid. In the unlikely event of a medical emergency such as a heart or asthma attack, we require you to provide us with some emergency contact details. Please ensure that the person you nominate below is aware of your medical history and will be available to contact on the day of your training. Who would you like us to contact in the unlikely event of an emergency? Name Dr.MissMr.Mrs.Ms.Prof.Rev. Prefix First Last Telephone: Mobile*Telephone: OtherRelationship: How this is person related to you?* SECTION D NOMINATE A THIRD PARTY TO PAY FOR THIS COURSEIs this course being paid for by a third party such as an employer, school, employment agency or other organisation?* NO YES If Yes, please complete the details below Organisation Name Organisation ABN (Australian Business Number) Contact Person* Organisation Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Organisation | Contact Telephone*Organisation | Contact Email Address* Enter Email Confirm Email SECTION E TERMS AND CONDITIONS & STUDENT DECLARATIONPlease take a moment to review our standard enrolment terms and conditions by clicking the following link: Enrolment Terms and ConditionsPLEASE NOTE:TO SUBMIT THIS ENROLMENT FORM, YOU MUST AGREE TO ALL THE TERMS AND CONDITIONS LISTED BELOW & SIGN YOUR NAME WHEN PROMPTED. STUDENT DECLARATION* I declare that the information I have provided, to the best of my knowledge, is true and correct. I have read and understood the above privacy notice and the terms and conditions related to my enrolment, including those terms and conditions related to government restrictions and lockdowns due to COVID-19 as found on https://www.its.vic.edu.au/enrolment-terms/. I understand that I am enrolling into this course and therefor agree to pay all the fees and charges listed on this enrolment form. I also understand that if I nominate a third party to pay for my enrolment fees and they do not make payment, I will not receive a Certificate of Completion and, as the enrolled student, may remain liable for the course fees. I understand that I must give Intelligent Training Solutions 7-days notice if I cannot attend this course. Should I fail to provide 7-days notice, I understand that I am liable and must pay the FULL course fees. Failure to do so will result in my account being sent to a debt collection agency. You must tick all the boxes above to be presented with the 'SUBMIT YOUR ENROLMENT' button. If you have any concerns about our terms and conditions, please contact our office on 03 5415 0204 during business hoursSTUDENT SIGNATURE* OPTIONAL ADDITIONAL PRODUCTS & PAYMENT DETAILSSURVIVAL WORKPLACE First Aid Kit - $149.95 Add SURVIVAL Workplace First Aid Kit Tick off every item on your first aid kit checklist with this SURVIVAL First Aid kit. Suitable for home and compliant for workplaces, this kit contains all the components you need to deal with a First Aid emergency. NOTE: This kit is Nationally compliant with Safe Work Australia's Health and Safety Code of Practice and is therefore approved for use within a workplace. For more information on this kit or to see a full list of the items included, visit: SURVIVAL EMERGENCY SOLUTIONS SURVIVAL Snake Bite Kit - $74.95 Add SURVIVAL Snake Bite Kit Designed in Australia by leading first aid experts and developed in conjunction with snake safety experts (SSSafe), the SURVIVAL Snake Bite Kit is built around the success of SURVIVAL's revolutionary smart bandage to effectively manage potentially deadly snake and funnel-web spider bites. This kit also contains life-saving instructions on correct snake bite bandage techniques. For more information on this kit or to see a full list of the items included, visit: SURVIVAL EMERGENCY SOLUTIONS Section BreakPREFERRED PAYMENT METHODYOUR PREFERRED PAYMENT METHOD* PAY ON INVOICE PAY VIA PAYPAL - ADDITIONAL 2.7% + .30c PAY VIA CREDIT CARD - ADDITIONAL 3% + .30c By selecting 'PAY ON INVOICE' our admin team will send an invoice to the email address you provided on this form. This invoice may take up to 2 working days to arrive.By selecting 'PAY VIA PAYPAL' you will be transferred to the PayPal system upon submitting your enrolment form. You do not need a PayPal account to complete your purchase.By selecting 'PAY VIA CREDIT CARD' you will be transferred to our STRIPE system upon submitting your enrolment form. From here you will be able to securely complete your purchase using your credit card.TOTAL ENROLMENT FEE $ 0.00 EmailThis field is for validation purposes and should be left unchanged.
