Enrolment In: On-Road Defensive Driver Course (One on One) "*" indicates required fields Step 1 of 7 14% Enrolment Form for NON-Accredited Courses EMAIL: ENROLMENT@ITS.EDU.AU | CALL: 1300 585 866 | WEB: WWW.ITS.EDU.AU Please read the following requirement for on-site learning as determined by the Department of Education, the Victorian Government, and the CHO.Click here if you are NOT fully vaccinated against COVID-19 GOVERNMENT VACCINE MANDATE ORDERS FOR TAFE | HIGHER EDUCATION | REGISTERED TRAINING PROVIDERS AND TRAINING SECTORS As of Monday 01st of November 2021, in line with the Public Health Advice, the Victorian Government together have mandated that all students and staff attending a training venue on-site across any TAFE, Higher Education provider (universities), or Registered Training Organisations (RTOs) throughout Victoria must be fully vaccinated against COVID-19 or have been issued with an approved medical exemption. This includes: 1) All students over the age of 16 coming on-site to any training venue must be fully vaccinated or have a valid medical exemption; 2) Students excluded from the fully vaccinated requirement: 2a) All VETDSSS and VCAL students (irrespective of age) 2b) All students under the age of 16 3) Students who are unvaccinated or have had their first dose only, will not be able to come on-site until they are fully vaccinated or have a valid medical exemption. As per these requirements, a COVID marshal will be present at all entry points accessed by patrons to check and confirm your Vaccination Certificate or Approved Medical Exemption. If you cannot provide evidence of being fully vaccinated or of an approved medical exemption on the day of your training, you will be unable to participate in your class and will forfeit your enrolment fees. SECTION A COURSE ENROLMENT CONFIRMATIONOn-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 ENROLMENTSHave you previously applied to, or been enrolled at Intelligent Training Solutions?*NOYESIf Yes, please state your I.T.S Student ID number (If known) example: ITS000123XHas your name changed since your last enrolment with us?NOYESIf Yes, you must provide documentary evidence (Marriage Certificate etc...)If Yes, please enter your previous name Please enter your previous FULL legal name SECTION CPERSONAL DETAILSName* Dr.MissMr.Mrs.Ms.Prof.Rev.Other Prefix First Middle Last Date of birth* DD slash MM slash YYYY Select your date of birth using the calendar to avoid formatting errorsCONTACT 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: HomeTelephone: Mobile*Your preferred email address* Enter Email Confirm Email RESIDENTIAL ADDRESS Address* Street Address Address Line 2 Suburb State Post Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin 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 ADDRESS Is 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 Suburb State Post Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country SECTION D EMERGENCY CONTACT DETAILSThis 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* Dr.MissMr.Mrs.Ms.Prof.Rev.Other Prefix First Middle Last Telephone: Mobile*Telephone: OtherEmail - (Optional) Address - (Optional) Street Address Address Line 2 Suburb State Post Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Relationship: How this is person related to you?* SECTION E 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 Dr.MissMr.Mrs.Ms.Prof.Rev.Other Prefix First Last 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 IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Organisation | Contact Telephone*Organisation | Contact Email Address* Enter Email Confirm Email SECTION F NOMINATE YOUR PREFERRED COURSE DATE AND TIMEPlease 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* DD slash MM slash YYYY 2nd Preference* DD slash MM slash YYYY 3rd Preference* DD slash MM slash YYYY What is your preferred start time? Hours : Minutes AM PM AM/PM SECTION G DRIVERS LICENCE REQUIREMENTSDo 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 licenceDo 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 DECLARATIONPLEASE 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 hoursSTUDENT SIGNATURE* SECTION I ADDITIONAL PRODUCTS & COURSE OPTIONS RELATED TO YOUR ENROLMENTPLEASE 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. SURVIVAL WORKPLACE First Aid Kit - $159.95 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 Printed (Hard Copy) Certificate- $9.95 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 optionPREFERRED PAYMENT METHODPLEASE SELECT YOUR PREFERRED PAYMENT METHOD* PAY ON INVOICE PAY VIA PAYPAL - ADDITIONAL 2.9% + .30c PAY VIA CREDIT CARD - ADDITIONAL 2.9% + .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 CommentsThis field is for validation purposes and should be left unchanged.