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  • Students Regisration Form

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    Victor Muthomi Nyagah
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    THIIRI C.T.C STUDENT REGISTRATION FORM GENERAL information FIRST NAME_________________________ Last name___ __________________________ Date of Birth / / (Male / Female) Mailing Address ____________________________ Country ____________________ Email _______________................ Phone: ______________ (if under 18) Parental / Guardian Contact Information (please provide if registrant is under 18)

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    Students Regisration form

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    THIIRI C.T.C STUDENT REGISTRATION FORM GENERAL information FIRST NAME_________________________ Last name___ __________________________ Date of Birth / / (Male / Female) Mailing Address ____________________________ Country ____________________ Email _______________................ Phone: ______________ (if under 18) Parental / Guardian Contact Information (please provide if registrant is under 18)

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    37 views3 pages

    Students Regisration Form

    Uploaded by

    Victor Muthomi Nyagah
    THIIRI C.T.C STUDENT REGISTRATION FORM GENERAL information FIRST NAME_________________________ Last name___ __________________________ Date of Birth / / (Male / Female) Mailing Address ____________________________ Country ____________________ Email _______________................ Phone: ______________ (if under 18) Parental / Guardian Contact Information (please provide if registrant is under 18)

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 3

    THIIRI C.T.

    C STUDENT REGISTRATION FORM

    GENERAL INFORMATION
    REGISTRATION DATE______/_______/_____________

    First Name_________________________ Last Name_________________________


    Date of Birth / / / (Male/Female)
    Mailing Address ___________________________________
    Country __________________________________ Email _____________________________
    Phone: _____________________
    Work ______________________________

    Parental / Guardian Contact Information (Please provide if


    registrant is under 18)
    Name________________________________________________
    Phone_________________________________

    Emergency Contact Information (if different from above)


    Name_____________________________________________________
    Phone_____________________________________________
    Relationship__________________________

    I certify that the above information is true _____________________


    (Students Signature)
    TO BE FILLED BY THE INSTRUCTOR

    PACKAGES TAKEN
    Package title Date Started Day/class time Date Rating
    ended

    Comments_________________________________________________________________________________
    _____________________________________________________________________________________________
    _____________________________________________________

    Instructor’ s Name________________________________
    Signature__________________________

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