Accomodation Form Personal Emergency Health Rules Declaration Personal information Full Names * Surname * ID Number / Passport Number * Email Address * Mobile Contact Number * Alternative Contact Number Course Name Attending * Training Dates * Room Number (Office Use) Emergency contact details Emergency Contact Person * Relationship * Emergency Contact Number * Alternative Emergency Number Residential Address of Emergency Contact Health information checklist Do you suffer from epilepsy or seizures? Yes NoDo you suffer from asthma? Yes NoDo you have diabetes? Yes NoDo you have severe allergies? Yes NoDo you have heart conditions? Yes NoDo you take medication that may affect concentration? Yes NoHave you previously experienced fainting or blackouts? Yes NoAny other medical condition we should be aware of? Yes No If yes, please explain Preferred Doctor / Clinic Doctor Contact Number Snakes Spiders Insects Other small wildlife Accommodation rules agreement I will respect the property and facilities of the institution. * I will not damage furniture, doors, walls, or equipment. * I understand that I will be responsible for any damage caused. * I will make my bed every morning. * I will clean my room every morning. * I will keep the accommodation clean at all times. * I will clean the shower after using it. * I will clean the toilet after use. * I will clean the sink / basin after use. * I understand that I must bring my own blankets, bedding, toiletries, and personal items. * I understand that the institution is not responsible for lost personal belongings. * No smoking inside the accommodation building. * No alcohol or illegal substances are allowed. * No ritual practices or ceremonies are allowed inside the house. * I will respect the religion and beliefs of others. * Visitors are not allowed inside sleeping rooms. * I will stay only in the room allocated to me. * Female learners will not share rooms with male learners. * I will follow instructions given by the Hostel Manager. * I will not feed animals on the property without permission. * I will not disturb animals on the property. * Declaration Learner Full Name * Signature (type your full name) * Date * Office use only fields remain available in the dashboard after submission so staff can record room allocation and check-in details later. Back Next Submit Accommodation Form
