This form must be handed in to your Regional HFPA Office together with a copy of your deposit slip.

Students registering at the Rivonia Campus

Fax forms to: Fax: Post to: Tel: HFPA - RIVONIA (011) 234-3333 P.O. Box 2075, Rivonia, 2128, South Africa 011 807-9673

Banking details
Account Name: Bank: Branch Code: Account Number: Health & Fitness Professionals Academy (Pty) Ltd First National Bank (Kloof Branch) 221526 50730284854

NB

The first 2 pages of this registration document and the

relevant form A,B or C must be completed. Form D must be completed where a surety agreement is required. (refer to page 15) Please print clearly and ensure that all information is complete and correct. Circle T-Shirt size (on next page). Incomplete forms will be returned.

Registration Form - Full Time 2013

Personal details
Title: First Names: Race (DOE Requirement): I.D. Number: Residential Address: Home Language: Date of Birth: Surname:

Code: Postal Address:

Code: Tel No: (W) Fax No: e-mail address: Employer: Address: Occupation: Tel No: (H) Cell Phone:

Code: Tel: Name of Relative or Friend not living with you: Tel: Where did you hear about HFPA: Have you excelled in any sporting/fitness industry?
(e.g. provincial sporting achievement, fitness modeling, etc.)

Registration Form - Full Time 2013

Full-time programmes
Students name: Please register me for the following course commencing: Campus: Day/s attending lecture:

Please tick the relevant boxes

Note: Course pack

For your convenience we have put together a pack containing study materials and other items which you will need on the course. Course Pack Fee: R2500 (This pack must be purchased before you commence the course).

The Pack includes the following

HFPA Manuals (Theory, Practical & Student manuals + Assignments) HFPA DVD Testing Equipment (Skin Fold callipers, Blood Pressure monitoring equipment) Student Card (Please provide 2 x passport size photos) HFPA Water Bottle HFPA Carry bag Electives Course Material HFPA T-Shirt (Please circle your T-shirt size: S M L XL XXL)

Registration Form - Full Time 2013

Payment options
All registration forms and documents must be handed into your regional HFPA office, or, in the case of Rivonia students, to the HFPA Head Office. For checking before posting to HFPA Head Office at P. O. Box 2075, Rivonia, 2128, together with the specified documents. Note that the Distance Learners and Rivonia registrations must be posted to Head Office.

Option 1: Payment in full in advance

Complete Official Course Registration Form and submit with the following documents: Form A completed and signed where indicated Proof of payment of the full course fee plus the cost of the course pack Copy of ID document Copy of Matric Certificate or equivalent Two ID photographs with your name printed on the back

Option 2: Study loan through a bank or financial institution

Complete Official Course Registration Form and submit with the following documents: Form B completed and signed where indicated Proof of payment of R2000 holding deposit HFPA will provide you with a letter stating that your registration is subject to a loan being granted. The letter will set out the fee structure for the course including the cost of the Course Pack and examinations. Once the loan has been granted HFPA will require: Written confirmation from the bank that the loan has been granted Copy of ID document Copy of Matric Certificate or equivalent Two ID photographs with your name printed on the back.

Registration Form - Full Time 2013

Payment options continued

Option 3: Payment on terms through HFPA
(This option applies only to prospective students who are unable to obtain a study loan through a bank or financial institution) In special circumstances HFPA will consider offering payment terms. In this case HFPA requires: A copy of the written notification from the financial institution that your loan application was unsuccessful Official Course Registration Form, if not previously submitted Form C completed and signed where indicated Proof of payment of R2000 holding deposit Copy of ID document Copy of Matric Certificate or equivalent 2 ID photographs with your name printed on the back Form D - Guarantee by parent/guardian/sponsor The applicant will be advised in writing by HFPA if the application for terms is approved 2 X recent credit references.

Applicable payment terms - Full Time Course

Diploma in Exercise Science - Part 1 Fee: R26 300. Deposit: R5000. Balance: R21 300 +10% = R23 430 Terms: R2343 per month for 10 consecutive months Diploma in Exercise Science - Part 2 (Fees and Terms as in Part 1 above)

Registration Form - Full Time 2013

Form A
Terms and conditions of application for registration Payment in full in advance

Course title:

Fee structure
Full fee of R: + R2500 (Course pack) = R

Payment instructions
Payment is to be effected by cheque deposit, electronic transfer or by credit card. Banking details are as follows: (Please forward proof of payment) Account Name: Bank Name: Branch Code: Account No.: HEALTH & FITNESS PROFESSIONALS ACADEMY (PTY) LTD First National Bank (Kloof Branch) 221526 50730284854

In the case of bank deposit or electronic transfer please use your initials and surname as the reference. If payment is made via credit card please complete the following:

Registration Form - Full Time 2013

Form A
continued
Cancellations (Please note: No exceptions will be made to this cancellation policy.)
There is a 10 day cooling off period from the date of registering for the course during which time the student may inform HFPA in writing that he/she wishes to cancel the registration. If this contract is cancelled during the cooling off period any tuition fees paid for this course, including the holding deposit, will be refunded. After the cooling off period no amendments or alterations to this contract shall be permitted and no refunds will be given. The Applicant shall not be entitled to withdraw from this contract for any reason. Should the Applicant be in breach of any obligations, despite 14 days written notice, HFPA shall be entitled to cancel this contract without further notice and without prejudice to any further claim. The Applicant shall not be entitled to refunds for any payments made. Study notes are subject to normal copyright restrictions and there will be no refund for material returned.

Examination fees

The examination fee is R250 per exam and this applies to all HFPA examinations (theory and practical).
The examination fee must be paid when registering for the examination. Examination fees are not refundable. Students are advised in advance of examination dates. Registration deadline is 6 weeks prior to the examination date. Late registrations may be accepted but incur a penalty of R100.

Read and signed by the applicant

I confirm my personal details on the Official Course Registration Form and that I have also read and understand the terms and conditions of registration set out above which are binding on me.

Signed: Applicant

Date:

Registration Form - Full Time 2013

Form A
continued Where the applicant is less than 18 years of age, a parent or guardian must duly assist as follows:
Signature of parent or guardian: Relationship: Name of parent or guardian: ID No.: Address:

Code: Telephone: Cell:

Registration Form - Full Time 2013

Form B
Terms and Conditions of application for registration Payment with a study loan from a bank or financial institution

Course title:

Fee structure
Full fee of R: + R2500 (Course pack) = R

Deposit of R2000 payable on submission of this form with balance payable before commencement of course

Payment instructions
Payment is to be effected by the lender Bank by way of electronic transfer. Banking details are as follows: (Please forward proof of payment) Account Name: Bank Name: Branch Code: Account No.: Reference: HEALTH & FITNESS PROFESSIONALS ACADEMY (PTY) LTD First National Bank (Kloof Branch) 221526 50730284854 Initials and surname of applicant

Cancellations (Please note: No exceptions will be made to this cancellation policy.)

There is a 10 day cooling off period from the date of registering for the course during which time the student may inform HFPA in writing that he/she wishes to cancel the registration. If this contract is cancelled during the cooling off period any tuition fees paid for this course, including the holding deposit will be refunded. After the cooling off period no amendments or alterations to this contract shall be permitted and no refunds will be given. The Applicant shall not be entitled to withdraw from this contract for any reason. Should the Applicant be in breach of any obligations, despite 14 days written notice, HFPA shall be entitled to cancel this contract without further notice and without prejudice to any further claim. The Applicant shall not be entitled to refunds for any payments made. Study notes are subject to normal copyright restrictions and there will be no refund for material returned.

Registration Form - Full Time 2013

Form B
continued
Examination fees

The examination fee is R250 per exam and this applies to all HFPA examinations (theory and practical).
The examination fee must be paid when registering for the examination. Examination fees are not refundable. Students are advised in advance of examination dates. Registration deadline is 6 weeks prior to the examination date. Late registrations may be accepted but incur a penalty of R100.

Read and signed by the applicant

I confirm my personal details on the Official Course Registration Form and that I have also read and understand the terms and conditions of registration set out above which are binding on me.

Signed: Applicant

Date:

Where the applicant is less than 18 years of age, a parent or guardian must duly assist as follows:
Signature of parent or guardian: Relationship: Name of parent or guardian: ID No.: Address:

Code: Telephone: Cell:

Registration Form - Full Time 2013

10

Form C
Terms and Conditions of application for registration Payment on terms
Please refer to page 15 to establish whether a Surety Agreement must accompany this application. Course title:

Fee structure
Full fee of R: Deposit of R: + 10% interest, amounting to R to be paid in commencing on the first day of and payable thereafter on the first day of each successive month. The deposit or balance of deposit and Course Pack fee shall be paid before the first day of the month following that month in which the payment plan is accepted by HFPA; Late payments, i.e. seven days or later after the due date, will incur an administration fee of R250 per month; If any installment remains unpaid for a period of 21 days or more, the student will not be permitted to continue with the course until all outstanding fees are paid. If debt collectors and/or attorneys are instructed to recover any amounts due, the student will pay all costs and collection charges. monthly installments of R + R2500 (Course pack) = R The balance of R

Payment instructions - Circle which applies to monthly payments

Payment is to be effected by: Cheque Electronic transfer Credit card Debit order

Registration Form - Full Time 2013

11

Form C
continued
Banking details are as follows: (Please forward proof of payment) Account Name: HEALTH & FITNESS PROFESSIONALS ACADEMY (PTY) LTD Bank Name: Branch Code: Account No.: Reference: First National Bank (Kloof Branch) 221526 50730284854 Initials and surname of applicant

Application for terms

I applied for a study loan through (Bank/Financial Institution) but my application was unsuccessful. Copy of the written notification from (Bank/Financial Institution) is attached. I now wish to apply to Health & Fitness Professionals Academy (Pty) Ltd to accept payment on the terms in this Application.

Credit references
1.Company Name: Contact Person: Address: Tel: 2. Company Name: Contact Person: Address: Tel: Company Name:

Registration Form - Full Time 2013

12

Form C
continued
Cancellations (Please note: No exceptions will be made to this cancellation policy.)
There is a 10 day cooling off period from the date of registering for the course during which time the student may inform HFPA in writing that he/she wishes to cancel the registration. If this contract is cancelled during the cooling off period any tuition fees paid for this course, including the holding deposit will be refunded. After the cooling off period no amendments or alterations to this contract shall be permitted and no refunds will be given. The Applicant shall not be entitled to withdraw from this contract for any reason. Should the Applicant be in breach of any obligations, despite 14 days written notice, HFPA shall be entitled to cancel this contract without further notice and without prejudice to any further claim. The Applicant shall not be entitled to refunds for any payments made. Study notes are subject to normal copyright restrictions and there will be no refund for material returned.

Examination fees

The examination fee is R250 per exam and this applies to all HFPA examinations (theory and practical).
The examination fee must be paid when registering for the examination. Examination fees are not refundable. Students are advised in advance of examination dates. Registration deadline is 6 weeks prior to the examination date. Late registrations may be accepted but incur a penalty of R100.

Read and signed by the applicant

I confirm my personal details on the Official Course Registration Form and that I have also read and understand the terms and conditions of registration set out above which are binding on me.

Signed: Applicant Duly assisted by Signature

Date:

(full name of parent/guardian)

Where the applicant is less than 18 years of age the assistance of a parent or guardian is required above. Please also complete the details on the following page.

Registration Form - Full Time 2013

13

Form C
continued
Detail of Parent or Guardian

Form D must be completed and signed by the relevant surety in all the following cases.
Where the applicant is less than 18 years of age Where the applicant is currently unemployed Where the applicant is unable to provide credit references Where a parent, guardian or sponsor is responsible for payment of fees arising from the tuition agreement entered into in accordance with the Application for Registration Form C signed by the student.

Signature of parent or guardian: Relationship: Name of parent or guardian: ID No.: Address:

Code: Telephone: Cell:

Registration Form - Full Time 2013

14

Form D
Annexure to Form C Surety agreement for student applying for payment on terms
I, (full names): Identity No. (hereafter the Surety) of (full residential address)

Code: Telephone: Cell: guardian sponsor

Relationship, if any, to the student (circle which is applicable) parent

hereby bind myself as surety in solidum for and co-principal debtor jointly and severally with (full names of student) (hereafter the Student) to Health & Fitness Professionals Academy (Pty) Ltd (hereafter HFPA) for the payment by the Student of all sums of money which are now or may hereafter become due and payable to HFPA arising from the tuition agreement to be entered into or already entered into in accordance with the Application for Registration Form C signed by the Student. I acknowledge that I have read and understand the said Application and I hereby renounce the benefits of excussion and division, which I understand. I choose as my domicile for the purposes of this suretyship my said residential address. Signed by the Surety at day of 2013. this

As witnesses
1. Surety 2.

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15