Enrolment In: ASSISTING CLIENTS WITH MEDICATION (VOC) COURSE – Connecting Staff – Saturday 04th May 2024 Step 1 of 7 14% ENROLMENT FORM - VERIFICATION OF COMPETENCE (VOC) COURSE EMAIL: ENROLMENT@ITS.EDU.AU | CALL: 1300 585 866 | WEB: WWW.ITS.EDU.AU SECTION A - COURSE REGISTRATION CONFIRMATIONAssist Clients with Medication (VOC) Course - 2.30pm to 4.30pm(Required) Price: Verification of Competence - Professional Development CourseEstimated Enrolment Cost SECTION B - PREVIOUS APPLICATIONS AND/OR ENROLMENTSHave you previously applied to, or been enrolled at Intelligent Training Solutions?(Required) NO YES UNSURE Has your name changed since your last enrolment with us?(Required) NO YES If Yes, please enter your previous name(Required)Please enter your previous FULL legal name SECTION C - PERSONAL DETAILSPlease enter your full name(Required) Dr.MissMr.Mrs.Ms.Mx.Prof.Rev. Prefix First Middle Last PLEASE NOTE: This will be the name we print on your Certificate of Competence. Please enter your D.O.B(Required) DD slash MM slash YYYY Gender?(Required)WOMENMANNON BINARYCONTACT DETAILSTelephone: Mobile(Required)Would you like to provide with us an alternative number? NO YES Telephone: Other(Required)Your preferred email address(Required) Enter Email Confirm Email RESIDENTIAL ADDRESS Address(Required) 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 ADDRESSIs your mailing address the same as your residential address?(Required) NO YES Please enter your mailing address below. Please enter your mailing address(Required) Street Address Address Line 2 City 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 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 D - EMERGENCY CONTACT DETAILSWould you like to provide us with your preferred emergency contact?(Required) NO YES 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?Emergency Contact Full Name(Required) Dr.MissMr.Mrs.Ms.Mx.Prof.Rev. Prefix First Last Emergency Contact Persons Mobile Number(Required) 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, sporting club, employment agency or other organisation?(Required) YES SECTION F - ENROLMENT PRIVACY NOTICE & TERMS AND CONDITIONSTERMS AND CONDITIONS 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 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/. SECTION G - 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(Required) I declare that the information I have provided, to the best of my knowledge, is true and correct. I consent to the collection, use and disclosure of my personal information in accordance with the Privacy Notice listed above. I understand the terms and conditions of this written agreement, including the refund policy. I have been advised and understand the fees involved with my enrolment and agree to be a student of Intelligent Training Solutions Pty Ltd (RTO: 22570) I agree to pay all the fees and charges associated with my enrolment. I understand that if I nominate a third party 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 eight days notice if I cannot attend this course. Should I fail to provide eight (8) 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 understand that failure to officially withdraw from a course, as stated in the refund clause, will result in a vacant position within the course and will deprive I.T.S and the course from the revenue it would provide. I understand that I can view my own records held by Intelligent Training Solutions by contacting the administration office. 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. Select AllIf you have any concerns about our terms and conditions, please contact our office on 03 5415 0204 during business hoursSTUDENT SIGNATURE(Required) BEFORE YOU GO - CHECK OUT THESE FIRST AID RELATED PRODUCTS YOU MAY BE INTERESTED IN! TOTAL COST CommentsThis field is for validation purposes and should be left unchanged.