Student Registration

Registration fee paid EFT Cash Date:

Accepted by Date:

T-Shirt Size

Name of course

Nationality

Ethnicity

Title:

MR MS Miss

Sex

M F

Names :

Name ( As per ID )

Surname ( As per ID)

I.D number:

ID number

Passport no:

Address:

residential Address:

Postal Code:
Address:

Postal Address:

Postal Code:

Contact details:

Cell phone number: Back up number:

Email address:

Next of kin name: Contact:

Next of Kin Name: Contact:

Allergies / Medical conditions:

(Ensure the student brings any medical device to class i.e. asthma pump, epinephrine pen, insulin etc.)

Doctors details & number:

……………………………………………………………………………………………………………………………………………………………………..

Medical Aid name and no:

……………………………………………………………………………………………………………………………………………………………………..

I hereby give consent to the Star Quality management team to make decisions regarding the students well being in case of Medical
Emergency should the guardians/parents be unavailable

Student Signature………………………………………………………………………………………………………………………………………………..

Date: …………………………………………………………

Parent/guardian signature ( if student is under 18 years of age) …………………………………………………………………………..

Date……………………………………………………………

*please return this form fully completed to our head office 22 Niger Road Emmerantia or email it to
admin@starquality.co.za with proof of your registration fee. For any further queries please call us on 0110365666

Banking details-

First National Bank Rosebank

Branch Code: 250655

Account no: 62439149974

REFFENCE!!!! Please insert your student name and Surname or invoice number!

I, the undersigned (student/legal guardian) hereby accept/consent to

him/her undertaking the said lesson(s), and commit myself as surety and co-principal debtor of the fees and accept all the conditions as
described herein before.

Signed at on the day of 20

Student /Parent