Free Course Registration Form Template

Course Registration Form

Please complete this form to evaluate and capture the needs, interests, and preferences of students for course enrollment.

Student Information

Name

    Date of Birth

      Gender

        • Male

        • Female

        Address

          Phone number

            Email

              Emergency Contact Information

              Emergency Contact Name

                Relationship to Student

                  Phone number

                    Course Selection

                    Course Name

                      Course Code

                        Class Schedule

                          • Morning

                          • Afternoon

                          • Evening

                          Preferred Start Date

                            Payment Information

                            Payment Method

                              • Credit Card

                              • Debit Card

                              • Bank Transfer

                              • Cash

                              Consent and Acknowledgment

                              I certify that the information provided above is true and accurate to the best of my knowledge. I agree to comply with the course requirements and acknowledge that my enrollment may be subject to the institution’s approval.

                              Date:

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