Master Enrolment Form

COAPE SA Advanced Diploma in the Principles of Companion Animal Behaviour and Training

Course Enrolment Form

AB04 Course Enrolment

Course Details

Venue*

Student Number*

For COAPE SA and EMRA Advanced Diploma in Animal Behaviour

Student Details

First Name*

Surname*

Email*

Enter Email Confirm Email

Select ID Type

RSA ID
Passport

Country of Issue*

RSA ID Number*

Passport Number*

Home Language*

Please ensure that the information you have entered in portion of the form below is correct as this is the information required by the Accreditation body.

NOTE: Your application cannot be processed without this information.

Gender*

Date of Birth*

Ability Status*

Details of Disability*

Employment Status*

Occupation*

Any special dietary requirements?*

Yes
No

Dietary requirements?*

Please note: this course contains:

Practical assessment activities which involve sight, hearing, observation and physical interactions/ handling skills.
Client days which include Guided Client Consultations.
Hours to be logged at a Shelter.
Hours to be logged at an approved Training Faculty.
A 6 month Research Project.

If you believe you may have difficulties with any of these activities you must inform COAPE SA prior to enrolling.

Current Experience/Qualifications*

Reason for taking this course*

Student Contact Information

Cell Number*

Alternate Contact Number

Physical Address*

Street Address Suburb City Province/State Postal Code Country

Postal Address

Same as physical address

Postal Address*

Street Address Suburb City Province/State Postal Code Country

Person Responsible for Payment*

Who will be paying for the course?

Payee Information

First Name*

Surname*

Email*

Enter Email Confirm Email

Select ID Type

RSA ID
Passport

Country of Issue*

RSA ID Number*

Passport Number*

Cell Number*

Alternate Contact Number

Physical Address*

Street Address Suburb City Province/State Postal Code Country

Postal Address

Same as physical address

Postal Address*

Street Address Suburb City Province/State Postal Code Country

Payment Options

Dear Course Delegate

Please read the following form carefully as it contains details about paying by installment for your selected course.

Payment terms

The full course fee totals R38 000.00
A non-refundable deposit of R7,500.00

We offer the following payment options. Please indicate below which option you will take by selecting the applicable option.

Deposit Payment Options:

Option 1
Payment of full deposit @ R7,500.00

Option 2
Payment of 50% of the deposit, with the remaining 50% due in 1 month.

Payment Options:
1) Pay only the deposit, with the remainder due as per the terms & conditions (R7,500 or R3,750)
2) Pay the full course fee (R38,000.00)

Select Your Deposit Payment Option*

Course Fee Payment Options:

If you are not settling the full course fee today, then flexible monthly payments for the balance of the course fees (after payment of the deposit) are available.

Option 1
Full payment of remaining course fee within 1 month after registration (R30,500)

Option 2
A monthly Electronic Fund Transfer of R1 070 per month payable on the last day of each calendar month (commencing the 1st month-end after registration) for 18 consecutive months following registration.
These payments will need to be made by EFT into our bank account. Please contact us for more details.
This option includes a minimal 10% interest component.

Settlement Option (R3750 Deposit)*

Settlement Option (R7500 Deposit)*

Total Payable Today

R0.00

Payment Terms

Basic Terms & Conditions

Right of enrolment is reserved.
COAPE SA reserves the right to reschedule the course should the minimum number of students not enrol.
Final course information will only be sent out once full deposit amount has been paid.
The deposit must be paid in full prior to the 1^st lecture weekend to enable the student to attend.
Once a student has attended the first lecture weekend, he/she is liable for the full amount in terms of the option selected even if he/she decides to discontinue the course for any reason.
Attendance at all lecture weekends is mandatory for all Diploma students.
Late/non-payment of the monthly amount due could result in the following:
- Withholding of assignment marks until your account has been brought up to date.
- Withholding of assignment marks until your account has been brought up to date.
- You not being eligible to receive your next set of course notes or attend the next lecture weekend until your account has been brought up to date.
- The certification will only be issued to students who have settled the full amount due in terms of the option selected by the thirteenth (13^th) month.
You will be responsible for the postage fees of your certificate.
Courses are not transferable.

Full terms & conditions can be accessed on our website

Agree to terms*

Yes

I hereby agree to the abovementioned payment terms and undertake to fully settle the amount specified by the given date.

Referral Information

To assist in our marketing please can you tell us where you heard about us from?

How did you hear about us?

COAPE SA Rep*

Anthea Fuller
Danielle Pitt
Lerica le Roux
Renate De Villiers
Tayla Tucker
Toni Muller

Other (Please specify)

Magazines

Animal Talk
Dog Directory
SA Pet Pages

Personal Referral from?

Payment & Confirmation

Total Payable Now

R0.00

Name

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