Course Registration Form
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
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Male
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Female
Address
Phone number
Emergency Contact Information
Emergency Contact Name
Relationship to Student
Phone number
Course Selection
Course Name
Course Code
Class Schedule
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Morning
-
Afternoon
-
Evening
Preferred Start Date
Payment Information
Payment Method
-
Credit Card
-
Debit Card
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Bank Transfer
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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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