®

Unit 4, Rivonia Boulevard, Rivonia, Gauteng, 2191 | P.O Box 2075, Rivonia, 2128, South Africa
Tel: 011 807 9673 | Fax: 011 234 3333 | Email: info@hfpa.co.za | www.hfpa.co.za
Registration No. 2000/008172/07
Registered by the department of education for the qualifications as shown on certificate no. 2001/HE07/002

ALL COURSES registration Form

NB:
• All pages must be completed
• Incomplete forms will be returned
• You will receive an email shortly after submitting this form with further information on how to pro-
ceed with the registration process

Registration Form 2017 1

Personal details Self-Care:
No Difficulty Cannot yet be determined
Title: ____________________ Surname: ___________________________________________________________________ Some Difficulty May be part of multiple difficulties (TBC)
A lot of Difficulty May have difficulty (TBC)
First Names: ___________________________________________________________________ Gender: M F Cannot do at all Former difficulty - None now

Middle Name: ____________________ Known as: _________________________________________________________ Walking:

No Difficulty Cannot yet be determined
Date of Birth: _____________________________________ I.D. Number: _______________________________________ Some Difficulty May be part of multiple difficulties (TBC)
A lot of Difficulty May have difficulty (TBC)
Passport Number: ____________________________________ Nationality: ____________________________________
Cannot do at all Former difficulty - None now
Resident Status: ______________________________________ Marital Status: _________________________________
Residential Address: __________________________________________________________________________________
Race (DOE Requirement): _________________________ Home Language: __________________________________
________________________________________________________________________ Code: ________________________

communicating Postal Address: ______________________________________________________________________________________

No Difficulty Cannot yet be determined ________________________________________________________________________ Code: ________________________

Some Difficulty May be part of multiple difficulties (TBC)
A lot of Difficulty May have difficulty (TBC) Tel No: (W) _______________________________________ Tel No: (H) ________________________________________
Cannot do at all Former difficulty - None now
Fax No: __________________________________________ Cell Phone: ________________________________________
Hearing:
No Difficulty Cannot yet be determined Email address: _______________________________________________________________________________________
Some Difficulty May be part of multiple difficulties (TBC)
Where did you hear about HFPA: ______________________________________________________________________
A lot of Difficulty May have difficulty (TBC)
Cannot do at all Former difficulty - None now Do you have a matric or NQF level 4 equivalent: _______________________________________________________
Remembering:
No Difficulty Cannot yet be determined Details of account payer:
Some Difficulty May be part of multiple difficulties (TBC)
Title: ____________________ First Name: _________________________________________________________________
A lot of Difficulty May have difficulty (TBC)
Cannot do at all Former difficulty - None now Surname: _____________________________________ Email: _________________________________________________
SocioEconomic Status: Nationality: _______________________________ I.D/Passport Number: _____________________________________
No Difficulty Cannot yet be determined
Some Difficulty May be part of multiple difficulties (TBC) Cell Phone: _____________________________________
A lot of Difficulty May have difficulty (TBC)
Cannot do at all Former difficulty - None now Next of kin
Seeing: Title: ____________________ First Name: _________________________________________________________________
No Difficulty Cannot yet be determined
Surname: _____________________________________ Email: _________________________________________________
Some Difficulty May be part of multiple difficulties (TBC)
A lot of Difficulty May have difficulty (TBC) Nationality: _______________________________ I.D/Passport Number: _____________________________________
Cannot do at all Former difficulty - None now
Cell Phone: _____________________________________

Registration Form 2017 2 Registration Form 2017 3

extra information
Do you have access to a computer: Y N
Do you have access to the internet: Y N dent may inform HFPA in writing that he/she wishes to cancel the registration. If this contract is cancelled
Do you have access to a camera phone or digital camera: Y N ed
Are you an employee of Virgin Active: Y N
Are you an employee of Planet Fitness: Y N
What is your T-Shirt Size (Does not apply to short courses): S M L XL XXL
Students name: ______________________________________________________________________________________
Please register me for the _____________________________________________________________________ course
Study Mode: _________________________________________________________________________________________
Campus: _____________________________________________________________________________________________
Registration Form 2017 2
CANCELLATION POLICY FOR HFPA COURSES
(Please note: No exceptions will be made to this cancellation policy)
• There is a 10-day cooling off period from the date of registration for the course during which time the stu-
during the cooling off period any tuition fees paid for this course, including the holding deposit will be refund-
• After the cooling off period no amendments or alterations to this contract shall be permitted and no refunds
will be given
• The Applicant shall not be entitled to withdraw from this contract for any reason
• Should the Applicant be in breach of any obligations, despite 14 days written notice, HFPA shall be entitle to
cancel this contract without further notice and without prejudice to any further claim. The Applicant shall not
be entitled to refunds for any payments made
• Study notes are subject to normal copyright restrictions and there will be no refund for material returned.
Short Courses Cancellation Policy
• HFPA reserves the right to postpone/cancel a course should a minimum number of registrations not be
achieved. If cancelled by HFPA, the course fee will be refunded.
• Cancellations (Please note: No exceptions will be made to this cancellation policy.)
• The R500.00 BOOKING FEE applies specifically to the course as stated on this registration form and is
non-refundable unless the course is cancelled by HFPA.
• The full course fee is payable before commencement of the course. No cancellations will be accepted after
commencement of the course, i.e. full fee is payable according to the contract signed and no refunds will be
given.
• Payment over 3 months may be arranged for students registering for the Mandatory units together with a
continuing education course. In this case the total course fee is divided into 3 equal payments with the Book-
ing Fee deducted from the final installment.
• Installments must be paid before the 7th of the month in which they are due. Late payment or non-payment
in any one month will incur an administration fee of R250.00.
• Study notes are not returnable and are subject to normal copyright restrictions.
• Read and signed by the applicant
• I confirm my personal details on the Official Course Registration Form are correct and that I have also read
and understand the terms and conditions of the registration set out above which are binding on me.
I _________________________________________ have read and understood the HFPA cancellation policy.
Signature: ________________________________ Date: _____________________________
(Parent/legal guardian to sign, should the registered student be younger than 18 years of age)
I _____________________________________ , parent/guardian of ___________________________________ have
read and understood the HFPA cancellation policy.
Signature: ________________________ Date: _________________________
Registration Form 2017 2