Enrolment Form | Risingholme Community Centre, adult community courses, food, exercise, health, art, christchurch

Family Name/Surname:

Address:
Date of Birth*:

First Name:

Home Phone:

Work Phone:

Cell Phone*:

Email*:

For statistical purposes only - please tick
Gender: Male: Female:

Ethnicity: NZ European/Pakeha NZ Maori Pacific Island Peoples Asian Other

No Formal Secondary Qualification 14 or more credits at any level NCEA Level 1 or School Certificate

NCEA Level 2 or 6th Form Certificate University Entrance NCEA Level 1 or School Certificate Other

English language status: Native English Speaker Yes No

Start date:

Course you wish to enroll:

Location:

Fee:

How did you hear about us: Brochure Website Tutor Word of mouth

Preferred Payment Mode: Cash Cheque Internet Bank Visa/Mastercard

Internet banking 03 1598 0006558 00. Please add as reference your surname and course.
Help us to plan the best programme for you - why do you want to learn? Please tick all that apply to you:

To get a better job To increase my skills To start a new hobby To meet new people

To be more confident To be healthier/fitter To improve my business To keep myself busy

To learn something new