Course Application Document 2020

COURSE APPLICATION FORM – COMPANY THIS DOCUMENT IS THE INTELLECTUAL PROPERTY OF PRO ETHNOS FIRE AND RESCUE DOCUMENT DRAFTED BY JJ VAN STADEN Page 1

Course information and application

Should you have any enquiries regarding training please feel free to contact us at

Please read through our terms and Conditions for clients (Companies) and private student. Please submit a printed and signed copy of the course application form.

Required pass rate for all training. All training programs presented by Pro Ethnos Fire and Rescue has a minimum pass rate requirement, these requirements are; Formative Assessment 90% Summative Assessment 75% Practical Assessment 95% Assessments and Re-Assessment Students that do not meet the above pass requirements shall be deemed as “not yet competent”, Students will be given opportunity to be re-assessed at a set cost of R380.00 per assessment, Students will be required to apply for re-assessment (application is same as course application) Pro Ethnos will set the dates, times and location for the assessment, students will be provided with 7 days notice of the assessment date. If students fail to attend the assessment result will be marked as not yet competent and the re-assessment fee deducted. At No stage will the re-assessment fee be re-reimbursed to the students. Plagiarism

a) Any student that makes him/herself guilty of plagiarism in either the formative and/or summative assessments, such student will be removed from the relevant training program with immediate effect and shall the student fail the relevant formative and/or summative assessments;

b) Any student who has been removed from any program as a result of being found guilty of plagiarism shall not be allowed to reapply for any program offered by Pro Ethnos Fire and Rescue for a period of 12 (Twelve months);

c) Any fees paid by the student shall be forfeited and will not be refunded. On-Site training Venue – Client Equipment The client will insure that the following requirements are met, when training is conducted on the client’s site.

a) The training venue will be well ventilated, illuminated and have proper seating and tables for students to write.

b) All Equipment must be safe to use and meet the SANS, DMR and EN Requirements. c) All Students will have all the PPE required and the PPE must meet requirements according to SANS,

NFPA, EN

Signature

Blessed be the Lord my strength which teaches my hands to war, my fingers to fight

Pro Ethnos Fire and Rescue Registration No: 2015/267881/07 Income Tax No: 9016615255

Contact nr: (061) 482 3898 (Business Watsapp) 24 Hr Emergency Nr (063) 281 3502 Cell nr (061) 384 2617 Fax: (086) 763 0268 Web Address http://proethnosfire343.wix.com/pro-ethnos-fire Email: info@proethnosfire.co.za

Course Application Document 2020

COURSE APPLICATION FORM – COMPANY THIS DOCUMENT IS THE INTELLECTUAL PROPERTY OF PRO ETHNOS FIRE AND RESCUE DOCUMENT DRAFTED BY JJ VAN STADEN Page 2

Course application form Official use

Course reference Nr

Student reference Nr

Course information

Course Title

Course date

Application

Application Private Student Company

Application For Course Re-Evaluation

Student information

Student Initials

Student First Name

Student Middle Name

Student Surname

Student Id/ Passport Nr

Student Contact Nr

Gender Male Female

Student Type Private Company

Organization Contact details

Organization Name

Representative Name

Company Physical Address

Landline Contact Nr

Fax

Email

Mobile

Postal Address

Company Registration Nr

Company SARS Nr

How did you hear about the course?

Course Application Document 2020

COURSE APPLICATION FORM – COMPANY THIS DOCUMENT IS THE INTELLECTUAL PROPERTY OF PRO ETHNOS FIRE AND RESCUE DOCUMENT DRAFTED BY JJ VAN STADEN Page 3

Medical Information Please complete the following document for each student and attach to application form.

Are you medically Fit (able to perform physical activities)

Yes No

Do you suffer from fear of heights, enclosed spaces Yes No

Do you suffer from Hearing or visual disabilities Yes No

This is to certify that I, _________________________________________________, ID No. / Passport No. _____________________acknowledge, to the best of my ability that I am in good health, have no known medical problem and have not been advised by any qualified medical professional that would restrict my ability to participate in the training event. I recognize that participation in physical activity involves the risk of injury, to my person or my property. I acknowledge that whilst I participate, I do so entirely at my own risk. I shall not hold Pro Ethnos Services , its sponsor, officers, agents, appointed staff or instructors responsible or liable of any death, personal injury (whether fatal or otherwise), loss or damage to property and any other losses, damage, cost, expense whatsoever and howsoever which I may suffer or incur in the course of or consequent upon my participation in any activity conducted by Pro Ethnos Services, including without limitation as a result of any act, default, omission or negligence of the indemnities. All of the risks and dangers associated with the activities are assumed notwithstanding. I undertake at all times to use my best endeavours to train and complete in a safe and proper manner and not to do anything which would expose me or fellow trainees to unnecessary risk of injury. I further undertake at all times to take all reasonable safety measures for the protection of myself and fellow trainees and to inform Pro Ethnos Services of any concern I may have as regards to safety. I hereby agree that this Release and Waiver of Liability, Assumption of Risk and Indemnity Agreement extends to all acts of negligence by Pro Ethnos Services, its sponsor, officers, agents, appointed staff or instructors and any of the affiliated associates, sanctioning organizations, INCLUDING NEGLIGENT RESCUE OPERATIONS and is intended to be as broad and inclusive as is permitted by South African Law in which the activities is conducted

___________________ Signature of Participant ___________________ Contact No ___________________ Date

Course Application Document 2020

COURSE APPLICATION FORM – COMPANY THIS DOCUMENT IS THE INTELLECTUAL PROPERTY OF PRO ETHNOS FIRE AND RESCUE DOCUMENT DRAFTED BY JJ VAN STADEN Page 4

Student Name list (to be completed by companies)

Course Title Unit Standard

Course Date / / 201 Course Location

Student Initials Student Surname Student Id nr Student Date of Birth

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Course Title Unit Standard

Course Date / / 201 Course Location

Student Initials Student Surname Student Id nr Student Date of Birth

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Course Application Document 2020

COURSE APPLICATION FORM – COMPANY THIS DOCUMENT IS THE INTELLECTUAL PROPERTY OF PRO ETHNOS FIRE AND RESCUE DOCUMENT DRAFTED BY JJ VAN STADEN Page 5

Costing (please indicate if you may be utilizing the following facilities and quantities)

Accommodation Cost per Day R650.00 Number of days

Restaurant Breakfast/ Lunch/ Dinner = 3 meals

Cost Per Meal R95 Number of meals

Medicals (Requirement for all Driver/Operators, rescue & WOH and fire fighting students)

Cost Per Student R450.00 Number of medicals

Dover Testing (Requirement driver operator training and Rescue training)

Cost Per Student R950.00 Number of Dover

CPAT Fitness Evaluation (requirement for all Fire 1 & 2 and Rescue practitioner students)

Cost Per Student R180 Number of Evaluations

GYM Fees Cost Per Session R25 Number of sessions

Onsite Laundry Cost Per Load (Size of provided laundry Bag) R80

Number of loads

Course Payment Details (Please complete the following)

What method of payment would you be using

Electronic Fund Transfer (EFT) Fundi Student Card

What will you be conduction payment for Course Fee Accomodation Ressturant Medicals CPAt Gym Laundry

Fundi Student Card Nr