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Personal Details (Legal name as per photo ID, which will need to be sighted to verify legal name)

Family Name

Given Name

Passport No.

Other ID

Date of Birth

City of Birth

Gender

Postal Address

Suburb

State

Post Code

Landline No.

Office No.

Mobile No.

Email Address

Fax No.

USI

I give permission for Blue Lotus College Pty Ltd to access my Unique Student Identifier (USI) for the purpose of recording my results. If I do not have a USI in place, I am willing for Blue Lotus College Pty Ltd to set up my USI on my behalf.

Course of Enrolment

Course Code

Course Title

Date From

Date To

Course Delivery Mode

Where did you hear about this course?

Emergency Contact Details

Full Name

Relationship

Contact No.

Mobile No.

Student's Signature

Course Cost

Submission Date

Photo ID Sighted

Upload ID

In the event of an emergency do you give Blue Lotus College Pty Ltd permission to organise emergency transport and treatment and agree to pay all costs related to the emergency?

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Personal Details (Legal name as per photo ID, which will need to be sighted to verify legal name)

Course of Enrolment

Emergency Contact Details