Diploma Course Enrolment Form Name* First Last Address* Address Line 1 Address Line 2 Address Line 3 Postcode Email* Mobile Phone*Home PhoneDate of Birth* MM slash DD slash YYYY Current Occupation* Emergency Contact Name*The name of someone we can contact in the event of an emergency Emergency Contact Phone Number*The phone number of someone we can contact in the event of an emergency Pre-requisite*It is a requirement for you to have completed the Kinesiology Practitioner Course. Please state below the Instructor's name and the date completed. Relevant Professional/Complimentary Qualifications (If Any)Have you had/do you have any serious illnesses that you feel we need to know about and that may affect your studies?*Ths information helps TASK Tutors to understand your current health issues with regards to supporting you in class and helping you further. Yes I have/have had a serious illness. No I don't have/haven't had any relevant serious illnesses Please tell us moreHave you taken into account the amount of study time involved outside class hours and the cost of travelling?* Yes No Have you read the Diploma Course information on our website fully and carefully?* Yes No Do you agree to the specific conditions set out in the Student Code of Conduct TASK requires?* Yes No Please give your reasons for taking this particular course with TASK*I wish to apply for the course scheduled to commence on:* Please upload a photo of yourself*Max. file size: 32 MB.If we have not met you before it will be great to be able to greet you as you join the Academy.Would you like to join our Mailing List and receive complimentary self help techniques straight to your inbox?* Yes I consent to receiving regular, informative and helpful emails about courses, blog posts, products and special offers that may support my career and health. I am already receiving TASK's Newsletter No thanks, not right now Payment Terms*The Diploma Training Course is £1,950 including V.A.T. (Reg. No. 861 4135 39 U.K.) PLEASE NOTE: If for whatever reason you are unable to make a weekend and require a CATCH UP Module this will be an extra fee of £300 payable to the Tutor. If for any reason you withdraw from the course at any time the complete fee remains due for your secured place. Payment Schedule: I agree to pay the fee of £1,950 as follows: £500 deposit and £1450 two weeks before Orientation (Start of course) Total £1,950. £500 deposit with application then 6 months at £252 (inc. £60 admin fee) Total £2,012. Deposit*Booking deposits are non-transferable & non-refundable, once enrolled we cannot return the booking deposit for any reason other than cancellation of the course by ourselves or if government restrictions mean we can not run the course. I understand that the deposit is non refundable and non transferable other than for the reasons above. Confirmation and Agreement*I confirm that the information I have given on this form is correct, that I have read the online Diploma Training Information and fully understand TASK’s code of conduct and my responsibilities as a student of TASK. I confirm that I take full responsibility for my own health and health related decisions whilst I undertake this course. Please tick to agree Please sign in the box below.*You can sign here with the mouse or via your touchscreen. Click on the arrows on the bottom right if you wish to erase and start again.Diploma Course Deposit* Price: £ 500.00 Quantity: