Date of enrolment

Name (this will appear on your qualifications)

First name

Surname

Home Address

Street

Suburb

State/Province

Area Code

Country

Postal address if different from above

Postal address

Suburb

State/Province

Area Code

Country

Personal details

Company

Occupation

Date of birth

Gender

Home phone

Work phone

Mobile

Fax

Email

Country of birth

Do you speak a language other than English at home? If yes, please specify

NoYes If Yes

Are you proficient in English?

Very WellWellNot WellNot at all

Do you have any disabilities that we should be aware of? If so, please specify.

Highest school level completed

What year did you finish school?

How many private Pilates sessions have you done in the last 12 months and where. Please specify the method of Pilates you have been working on. If you are bridging, please state details below of your previous Pilates certification.

Employment status?

Other:

Reason for study?

To get jobIt was required forFor personal developmentTo get a job or promotionMy jobTo develop my existing businessTo change careersTo increase my skillsTo start my own businessTo get into another course

Other:

Relevant experience and background

Course details

Course name

Course location

Course Date

Application Declaration

This section must be completed

I would like to apply for enrolment with Authentic Pilates Education teacher training course. I agree to abide by the rules, protocol and student code of conduct set by Authentic Pilates Education and I agree to maintain proper behaviour during my enrolment. I understand my enrolment can be suspended or cancelled should I breach the rules and protocols, use inappropriate behaviour, or endanger others or myself.I understand that the deposit is due to be paid with this application with further instalments to be paid prior to each seminar and that all payments made are non refundable.I further agree to give Authentic Pilates Education 14 days notice if I do not intend to attend the course I have enrolled into and understand that the deposit paid will not be refunded.I have read and understood the Authentic Pilates Education Codes of Ethics.I understand and agree that I will apply these ethics to my work practice in accordance with the Authentic Pilates Education Student / Apprentice Code of Practice.

Name (signature):

Bank Details

I have just paid my deposit through online banking into the bank account shown below.



Transaction/Receipt number
Account name: Authentic Pilates
Bank: ANZ
BSB: 012227
Acc: 46713 7959

Please download your enrolment agreement, sign and hand it to your Teacher Trainer.