Enrolment In: On-Road Defensive Driver Course (One on One)

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Enrolment Form for NON-Accredited Courses

EMAIL: ENROLMENT@ITS.EDU.AU | CALL: 1300 585 866 | WEB: WWW.ITS.EDU.AU

SECTION A

COURSE ENROLMENT CONFIRMATION

On-Road Defensive Driver Course*

PLEASE NOTE: This enrolment form is for one person only. If you wish to add additional people to this course you will need to complete this enrolment form for each person.

Price:

SECTION B

PREVIOUS APPLICATIONS AND/OR ENROLMENTS

Have you previously applied to, or been enrolled at Intelligent Training Solutions?*

If Yes, please state your I.T.S Student ID number (If known)

example: ITS000123X

Has your name changed since your last enrolment with us?

If Yes, you must provide documentary evidence (Marriage Certificate etc...)

If Yes, please enter your previous name

Please enter your previous FULL legal name

SECTION C

PERSONAL DETAILS

Name*

Prefix First Middle Last

Date of birth*

Select your date of birth using the calendar to avoid formatting errors

CONTACT DETAILS

If 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: Home

Telephone: Mobile*

Your preferred email address*

Enter Email Confirm Email

RESIDENTIAL ADDRESS

Address*

Street Address Address Line 2 Suburb State Post Code 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 ADDRESS

Is your mailing address the same as your residential address?*

YES

Please enter your mailing address below.

Please enter your mailing address

Street Address Address Line 2 Suburb State Post Code Country

SECTION D

EMERGENCY CONTACT DETAILS

This course requires you to participate in classroom activities which may or may not involve outdoor training activities. In the unlikely event of a medical emergency such as a heart, asthma or anaphylaxis 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*

Prefix First Middle Last

Telephone: Mobile*

Telephone: Other

Email - (Optional)

Address - (Optional)

Street Address Address Line 2 Suburb State Post Code Country

Relationship: How this is person related to you?*

SECTION E

NOMINATE A THIRD PARTY TO PAY FOR THIS COURSE

Is this course being paid for by a third party such as an employer, school, employment agency or other organisation?*

YES

If Yes, please complete the details below

Organisation Name*

Organisation ABN (Australian Business Number)

Contact Person

Prefix First Last

Organisation Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Organisation | Contact Telephone*

Organisation | Contact Email Address*

Enter Email Confirm Email

SECTION F

NOMINATE YOUR PREFERRED COURSE DATE AND TIME

Please provide us with at least three preferred dates and time with which you can participate in this course. PLEASE NOTE: Our team will do there best to accommodate your preferences, however, Intelligent Training Solutions CANNOT guarantee you will get the preferences you nominate. You will be contacted by one of our team members shortly who will confirm our trainer's availability.

1st Preference*

2nd Preference*

3rd Preference*

What is your preferred start time?

Hours

:

Minutes

AM/PM

SECTION G

DRIVERS LICENCE REQUIREMENTS

Do you hold a current and valid Australian Drivers Licence, Learner Permit or International Licence?*

YES

NO

IMPORTANT NOTE: You cannot attend this course without either a valid and current Australian Drivers Licence or Learner Permit OR// an valid international drivers licence

Do you drive a manual or automatic vehicle?*

Manual Only (Gears)

Automatic Only

Both Manual and Automatic

Has your Australian Driver Licence, Learner Permit or International Licence recently been cancelled or suspended OR is scheduled to be cancelled or suspended?*

YES

NO

If your licence or learner permit has been suspended or cancelled, you cannot enrol into this course. If your driver's licence or learner's permit is pending suspension, please ensure that your licence will still be active prior to attending this course.
IMPORTANT NOTE: Failure to attend this course with a valid, current driver's licence or learner's permit will result in your trainer cancelling this course on the day. If we need to cancel your course due to you not having a valid licence or permit, you will be liable for the full cost of this course. No refunds are issued to participants who attend a defensive driving course without a valid drivers licence!

SECTION H

STUDENT DECLARATION
PLEASE 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 understand the terms and conditions of this written agreement, including the refund procedures. I have understand the fees and refund conditions of my enrolment and agree to be a student of Intelligent Training Solutions Pty Ltd.
I agree to pay all the fees and charges listed on this enrolment form. I understand that if I nominate a third part to make payment for this enrolment, I remain liable for all enrolment fees until such time as the nominated third party has settled the account.
I understand that I must give I.T.S 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.
I have made my own enquiries and believe that this training course is suitable for my personal and/or career purposes. I consider that, based on my educational attainment, capabilities, aspirations and interests, this training is appropriate for me.
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 hours
STUDENT SIGNATURE*

SECTION I

ADDITIONAL PRODUCTS & COURSE OPTIONS RELATED TO YOUR ENROLMENT
PLEASE NOTE: The following services, products and course options are optional and are not required as part of your enrolment. They serve as optional extras designed to assist you with your career.
STUDENT SPECIAL PRICE: Workplace / Home - First Aid Kit - $100.00 + Postage (RRP $143.00)
Add 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
Printed (Hard Copy) Certificate- $10.00
Add Printed Certificate
As part of your enrolment, you will receive a PDF copy of your Certificate.
To receive a PRINTED hard copy of your Certificate in the mail, please select this option
PREFERRED PAYMENT METHOD
PLEASE SELECT YOUR PREFERRED PAYMENT METHOD*

PAY VIA CREDIT CARD

PAY VIA PAYPAL

PAY ON INVOICE
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