Harris Training Course Enrolment Form

Title *
First Name *
Middle Name
Last Name *
NSN # (NZQA#)
Date of Birth *
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Address - If postal address is different from above
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Number
Mobile Number *
Email Address *
What course are you applying for. *
Course Date / DD / MM YYYY
Emergency Contact - Name *
Emergency Contact - Number *
Invoice To *
Email Address for account to be sent *
Company Purchase Order No.
Company Details
Company Name
Company Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Company Phone Number
Demographic Details
Citizenship Status *

Citizenship Status New Zealand citizen Australian citizen /permanent resident New Zealand permanent resident Other/ please state country Other/ please state country
Ethnicity
For New Zealand Maori, Please identify your iwi (you may list more than one)
Fees -
In signing this enrolment form you undertake to pay all fees as they become due and to meet any late fees and collection charges associated with debt recovery. The organisation’s policy on withdrawal and refund of fees may be obtained from Harris Training Services Ltd. Harris Training Services Ltd reserves the right to cancel this programme subject to numbers, with full or partial refund (as may be appropriate) of any fees paid for this programme. The requested programme may be subject to further criteria, which does not necessarily guarantee a programme place.

Rules -
In signing this enrolment form you undertake to comply with the published rules and policies of the Organisation with regard to attendance, academic progress, standard of dress, health and safety and behavior.

Declaration -
I declare that to the best of knowledge all the information supplied on, and with, this enrolment form is true and complete, I agree to abide by the conditions described above and I consent to the disclosure of personal information as described below.

I understand that is an offence to make a false declaration, including supplying false or misleading information.
Declaration and Compliance with the Privacy Act 1993

Privacy -
Harris Training Services Ltd collects and stores information from this form to comply with the requirements of the Ministry of Education (student statistical returns),New Zealand Qualifications Authority(Records of Learning registration and Unit Standard outcomes), Tertiary Education Commission(funding returns),Industry Training Organisations (funding and academic outcomes), Ministry of Social Development(confirmation of enrolment and academic outcomes) Inland Revenue Department(student loan interest rebate),Department of Immigration(if you are not a New Zealand citizen or permanent resident)and agencies who support particular students for scholarships and prizes, payment of fees or other awards(if you are a recipient of one of these awards).The information is also used to select students for qualifications, to manage internal administrative processes, and for internal reporting. Information about students may be supplied to, and sought from, other educational organisations for purpose of verifying academic records. In addition, when required by statute, the Institute releases information to Government agencies such as the New Zealand Police, Department of Justice, Ministry of Social Development and the Accident Compensation Corporation (ACC).In signing this enrolment form you authorize such disclosure on the understanding that Harris Training Services Ltd will observe the general conditions governing the release of information, as set out in the Privacy Act 1993 and the Post-compulsory Unique Identifier Code of Practice. You may see information held about you and amend any errors in that information. To do so, contact the Enrolments Office.

NB -
The Privacy Act came into force on 1 July 1993 with the stated aim of protecting the privacy of natural persons. It requires the Organisation to collect, hold, handler, use and disclose personal information in accordance with the twelve information principles in the Act: http://www.privacy.org.nz/privacy-act

National Student Index -
Please note that your name, date of birth and residency as entered on this enrolment be included in the National Student Index, and will be used in an Authorised Information Matching programme with New Zealand Birth Register. For further information please see http://www.nsi.govt.nz/ima
Draw your signature into the box below.

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Harris Training Course Enrolment Form

Harris Training Course Enrolment Form

Company Details

Demographic Details

Declaration and Compliance with the Privacy Act 1993