Student Registration Form

We are delighted that you wish to join one of our courses. Please read the following very carefully before proceeding:

This registration form is legally binding between AHA Courses Ltd and the person responsible for paying the fees and must be filled out by the feepayer and, where possible, the student wishing to attend the course should counter sign the form as well. If, however, the feepayer is under the age of 18 then a parent/guardian must also sign.

Once you have completed this, you will be sent an email with the means of payment for the deposit. In order for your place to be totally secure, we must receive payment of the deposit within 7 working days of the date of submission.

If you would prefer to print and post your registration form, you can download it here.

Student Details

Fields marked with * are obligatory

First Name (as it appears in passport) *

Preferred Name

Last Name (as it appears in passport) *

Date of Birth *

Which course would you like to join? *

Are you in possession of a passport valid until beyond the return date of the course? *

Yes

Passport Number *

Passport Issue Date *

Passport Expiry Date *

Place of Issue (eg. UKPA) *

Nationality *

Have you checked whether or not you require a Visa? *

Yes

I still have to do this

Address

Your Postcode / Zip Code *

Your Address (Line 1) *

Your Address (Line 2)

Your Address (Line 3)

Your Town *

Your County/State/Region *

Your Country *

Contact Details

Tel Code *

Student Home Telephone Number *

Tel Code *

Student Mobile Telephone Number *

Time Zone *

Best Time to Call *

Email *

Confirm Email *

Further Information

With which gender do you identify *

Where are/were you at school/university? *

For all of the above, please give details

Additional Notes

Parent/Guardian (1) Details

If you wish to register details for two parents please tick here

Parent/Guardian (1) Title *

If other, please specify

Parent/Guardian (1) First name *

Parent/Guardian (1) Last name *

Parent/Guardian (1) Preferred Name

Parent/Guardian (1) address is the same as the student

Address

Parent/Guardian (1) Postcode / Zip Code *

Parent/Guardian (1) Address (Line 1) *

Parent/Guardian (1) Address (Line 2)

Parent/Guardian (1) Address (Line 3)

Parent/Guardian (1) Town *

Parent/Guardian (1) County/State/Region *

Parent/Guardian (1) Country *

Contact Details

Parent/Guardian (1) Home Telephone Number *

Parent/Guardian (1) Mobile Telephone Number *

Parent/Guardian (1) Email *

Parent/Guardian (1) Confirm Email *

Parent/Guardian (2) Details

Parent/Guardian (2) Title *

If other, please specify

Parent/Guardian (2) First name *

Parent/Guardian (2) Last name *

Parent/Guardian (2) Preferred Name

Parent/Guardian (2) address is the same as the student

Address

Parent/Guardian (2) Postcode / Zip Code *

Parent/Guardian (2) Address (Line 1) *

Parent/Guardian (2) Address (Line 2)

Parent/Guardian (2) Address (Line 3)

Parent/Guardian (2) Town *

Parent/Guardian (2) County/State/Region *

Parent/Guardian (2) Country *

Contact Details

Parent/Guardian (2) Home Telephone Number *

Parent/Guardian (2) Mobile Telephone Number *

Parent/Guardian (2) Email *

Parent/Guardian (2) Confirm Email *

Fees

Who is paying the fees *

Fee Payer Name *

Fee Payer Address *

Fee Payer Home Phone *

Fee Payer Mobile Phone *

Fee Payer Email *

Fee Payer Email Confirmation *

PLEASE READ EACH OF THE FOLLOWING IMPORTANT ITEMS

Student Medical Statement:
AHA courses are open to anyone who wants to apply, but it must be safe for you to take part. If you have any concerns around your ability to participate due to medical reasons or an impairment, please contact us for a confidential chat on +44 (0) 1379 871800 or [email protected].

Do you currently have or have you ever suffered from any medical condition of which we should have knowledge, including recent injuries? *

Yes

Do you have any allergies or special dietary requirements of which we should have knowledge? *

Yes

Do you take any medication of which we should have knowledge? *

Yes

Do you currently or have you ever suffered from any mental health problems including (but not limited to) panic attacks, anxiety, depression, eating disorders or self harm? *

Yes

If yes, please give full details about all conditions past and present so we can best manage the course or assess the suitability of a student for the course.

If you have answered "Yes" to any of the above, please give details *

I agree to receiving medication as instructed and any emergency dental, medical, or surgical treatment, including anaesthetic or blood transfusion, as considered necessary by the medical authorities present. I will inform AHA as soon as possible of any changes to the circumstances above between now and the start of the course and will inform AHA immediately if I contract any contagious diseases four weeks before the start date of the course *

We have a gift of a hoody for you if attending a Gap Year Course or a T-shirt if attending a Summer Course. Please indicate which size you require *

SWIMMING - ONLY PARENT/GUARDIANS OF STUDENTS UNDER 18 YEARS OF AGE MUST CHECK THIS BOX

Our tutors are not trained lifeguards. Do you agree to your son/daughter/ward going swimming should he/she wish to? *

Yes

PLEASE READ & AGREE TO EACH OF THE FOLLOWING IMPORTANT ITEMS

Travel Insurance

I understand that by signing this form I undertake to organise comprehensive travel insurance for the duration of the course and I will ensure the policy covers all repatriation and medical expenses. *

Passports & Visas

I understand that by signing this form I undertake to ensure I have a valid passport for travel over the dates shown above and will organise any necessary visas for my course. *

Your Details

I understand that AHA Courses will securely hold my details on their database, in accordance with GDPR, will not pass them on to any third parties and will use them exclusively in connection with AHA courses and events. *

Do you know anyone who has attended an AHA course? *

Yes

If yes, give details

Do you know anyone who is coming on this course? *

Yes

If yes, give details

Photographs and Video

During our courses, AHA generates videos and photographs which may include your image and we would like to use these, with discretion, on our social media and website, with your permission. *

Very occasionally, there are images we would like to use on posters or in advertisements in which case we would seek your permission beyond this agreement.

The Deposit

I will send a deposit payment of £600 within 7 days of submission of this form. On receipt of this form we will email you details of how to make a deposit payment. Please note that we cannot accept any card payments at this time. Payments must be made via online transfer. Your place will only be secured on receipt of deposit payment. *

I/We have read the Terms and Conditions, taking special notice of the cancellation procedure. *

I/We have read the Health & Safety Advice for Covid 19. *

Feepayer Name *

Parent/Guardian Name *

Today’s Date *

Click the SUBMIT button below to make your booking.

Student Details

Address

Contact Details

Further Information

Parent/Guardian (1) Details

Address

Contact Details

Parent/Guardian (2) Details

Address

Contact Details

Fees

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