Participant Form Please Fill in all sections clearly if you have any queries please don’t hesitate to contact the training department Given Name: Surname: Email: Date of Birth: Gendar: MaleFemale Contact Details: Mobile: Other: Address: Suburb: Post Code: Emergency Contact Name: Mobile: Are you of Aboriginal or Torres Strait Isla NoYes, Aboriginal & Tores Strait IslanderYes, both Aboriginal & Torres Strait Islander Do you speak English at home? YesNo, I speak Do you have disability impairment or long term medical condition? NoYes, Please Specify Do you have any language, literacy or numeracy requirements to complete this course? NoYes, Please Specify Tick the bellow points: I understand i will be provided feedback throughout the course and will only be notified if a am not yet competentRLSSWA has provided the policies, procedures and terms of enrolmentI give permission for my statement of attainment to be sent to a third party such as an employer parent or teacher
