Diploma Enrolment Form | Green Tara College

Name *

First

Last

Spelling for your ITEC Diploma

Address *

Email *

Contact Numbers

Mobile Number *

Landline

Country Code

Emergency Contact 1

Emergency Contact 1 Phone Number

Emergency Contact 2

Emergency Contact 2 Phone Number

First Language

Language spoken at home

Occupation

Date of Birth

Do you have any previous ITEC qualifications *

Yes
No

ITEC Number *

If you already have an ITEC qualification

Copy of ITEC Certificate

Click or drag a file to this area to upload.

You will need to bring us a copy if unable to upload it here

Do you have any previous QQI or medical training qualification *

Yes
No

Copy of certificate

Click or drag a file to this area to upload.

You will need to bring us a copy if unable to upload it here

Previous relevant Training in Complimentary therapies

Any Special needs or Requirements that we can assist with in your Training

Previous Education

Proof of ID

Click or drag a file to this area to upload.

You will need to bring us a copy if you are unable to upload it here.

Please Note: It is YOUR RESPONSIBILITY to ensure you have any medications you may need for your current health conditions with you when training in the College.

eg: Inhalers, Epi-pen, etc.

Are you Pregnant

Yes
No

Do you suffer from any of the following

Please tick all relevant boxes

Have you had any injuries, illness or operations within the last 3 years

Yes
No

List any recent injuries, illness and diagnosis (within the last 3 years)

List any major or minor operations (within the last 3 years)

Have you ever been treated or hospitalised for psychological illness at any stage.

Yes
No

Please give Details *

Please follow the links for the documents

GDPR Agreement *

I consent to having this website store my submitted information so they can deliver the services

I give permission for Green Tara College to use this information for class purposes and to use texting and emailing and for further information

Terms and Conditions *

I have read and agree to the terms and conditions of booking at Green Tara College. I deem that all the information supplied by me is true and correct.

Code of Ethics *

I have read and agree to the terms in the Code of Ethics

Equipment List *

I have downloaded the necessary equipment list for my course.