Diploma Course Enrolment Form "*" indicates required fields 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 emergencyEmergency Contact Phone Number*The phone number of someone we can contact in the event of an emergencyPre-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*If we have not met you before it will be great to be able to greet you as you join the Academy.Max. file size: 32 MB.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: Total