Wildlife Tracking - Tracker Academy

POLYGRAPH TESTING

I understand that as a student applying to Tracker Academy, I need to acknowledge that I will take a polygraph test at the beginning of the course. If I fail the test, I will likely be removed from the course. The polygraph will ask questions regarding rhino poaching. I hereby declare that I am physically and mentally fit to participate in daily fitness training activities. *

I accept this and wish to continue.

PHYSICAL & MENTAL FITNESS

I hereby declare that I am physically and mentally fit to participate in daily fitness training activities. I confirm that I am free from any health conditions or ailments that could potentially prevent or limit my participation in such activities. *

I accept this and wish to continue.

SECTION A - TRACKER ACADEMY COURSE OPTIONS

WHICH TRACKER ACADEMY COURSES ARE YOU INTERESTED IN? *

Rhino Guardian: Counter-Poaching & Conservation
Tourism Tracker: Safari industry

SECTION B1 - PERSONAL DETAILS OF APPLICANT

TITLE *

ID NO *

GENDER *

Male
Female

DATE OF BIRTH *

PASSPORT NO

Passport Date of Issue

Passport Expiry Date

SURNAME (according to your ID-document) *

FIRST NAMES (according to your ID-document) *

PERMANENT RESIDENTIAL ADDRESS *

Include street, town/city, country and postal code.

CODE *

POSTAL ADDRESS *

CODE *

MOBILE/CELL NUMBER *

(Country & area dial codes where applicable)

WORK TELEPHONE NUMBER

(Country & area dial codes where applicable)

HOME TELEPHONE NUMBER

(Country & area dial codes where applicable)

EMAIL *

MARITAL STATUS *

Single
Married
Divorced
Widowed

POPULATION GROUP *

Asian
Black
Coloured
White

Have you ever been suspended or refused admission to any training and education or other institution? *

No
Yes

Have you ever been found guilty of a criminal offence? *

No
Yes

General health *

Good
Poor

Dependants (own children) *

Yes
No

Do you have any form of physical or mental disability? *

No
Yes

SECTION B2 - PARTICULARS REGARDING SCHOOL CAREER

HIGHEST GRADE PASSED *

DATE PASSED *

NAME OF HIGH SCHOOL *

CITY/TOWN WHERE SCHOOL IS SITUATED *

SUBJECTS PASSED AND SYMBOL/GRADE OBTAINED *

Enter one subject and symbol/grade per line.

SECTION B3 PARTICULARS REGARDING FURTHER EDUCATION

(attach copies of certificates)

Attach your certificates here

Click or drag files to this area to upload. You can upload up to 3 files.

Your files must be either pdf, docx, doc, jpg, jpeg, png, gif, ppt or tiff and no larger than 10Mb.

1. NAME & LOCATION OF INSTITUTION

Qualification #1 obtained

Year in which qualification #1 was obtained

2. NAME & LOCATION OF INSTITUTION

Qualification #2 obtained

Year in which qualification #2 was obtained

3. NAME & LOCATION OF INSTITUTION

Qualification #3 obtained

Year in which qualification #3 was obtained

SECTION B4 - PARTICULARS REGARDING PARENT(S)/GUARDIAN

PARENTS/GUARDIAN OCCUPATION *

TITLE *

INITIALS *

SURNAME *

PARENTS/GUARDIAN ADDRESS DETAILS *

PARENTS/GUARDIAN HOME PHONE

(please include all dialing codes)

PARENTS/GUARDIAN WORK PHONE

(please include all dialing codes)

PARENTS/GUARDIAN CELL PHONE *

(please include all dialing codes)

SECTION B5 - PARTICULARS OF 2 OTHER RELATIVES TO CONTACT IN CASE OF AN EMERGENCY

1. EMERGENCY CONTACT NAME & SURNAME *

TELEPHONE OFFICE

TELEPHONE HOME

CELL NO. *

RELATION TO YOU *

2. EMERGENCY CONTACT NAME & SURNAME *

TELEPHONE OFFICE

TELEPHONE HOME

CELL NO. *

RELATION TO YOU *

SECTION B6 - FINANCIAL INFORMATION

SECTION B7 - DECLARATION BY LEARNER

I, the undersigned, hereby declare as follows: *

CHECK BOX TO AGREE

1. That I will acquaint myself, and in future will keep myself acquainted with the contents of all Learner Rules & Regulations, as well as the contents of all TRACKER ACADEMY Policies and Procedures pertaining to learner and training affairs.
2. That I commit myself for the duration of my studies at the TRACKER ACADEMY, to comply with all operational duty requirements, which will include compulsory, non-remunerated duties performed during weekends and/or after normal training hours, which duties will form part of the minimum operational hours required for the successful completing of the training course offered by the TRACKER ACADEMY.
3. That I commit myself for the duration of my studies at the TRACKER ACADEMY to comply with all Rules and Regulations as determined by the TRACKER ACADEMY or any authorized body or person, which may be publicized and amended from time to time, which Rules and Regulations form part of any agreement with the TRACKER ACADEMY.
4. That all details provided to the TRACKER ACADEMY are true and correct, failing which my registration will be cancelled with immediate and automatic effect.
5. That the agreement resulting from the signing of this declaration and application for admission, notwithstanding the place of signing, is regarded by me as coming into effect in Graaff-Reinet, held that this application will only be seen as a valid and binding agreement after my official registration and enrolment at the TRACKER ACADEMY.
6. That I will immediately inform the TRACKER ACADEMY if my address should change.
7. I hereby renounce any possible action against the Tracker Academy, and I indemnify the Tracker Academy with regard to any possible claim that might result from the following:
a) Any loss of or damage to property including any consequential damage that directly results from the damage done to such property;
b) Any injury; illness or death;
c) Any event, incident or accident
d) Any legal costs or expenses with regard to claims or court cases that might result from the mentioned events
e) Any medical treatment costs, and all costs where such costs, losses, damages, illness, injury, death, event or incident results from my visit to and/or instruction, on and/or stay at the TRACKER ACADEMY, and/or any accompanying tour/outing, excursion/visit/experiential training or transport, which may occur during my study period at the TRACKER ACADEMY which could not reasonably have been prevented by the TRACKER ACADEMY.
8. I accept that I participate in all activities attaching to my training at TRACKER ACADEMY at my own risk, and I accept the risk that is associated therewith.
9. I accept that the TRACKER ACADEMY may request, at its sole discretion and at any time during my training at the TRACKER ACADEMY, a medical certificate/report from a medical practitioner appointed by the TRACKER ACADEMY, in regard to my physical and/or mental health.
10. Irrespective of any bursary or loan to be received or already received, I herewith accept, as the responsible person, liability for the payment all applicable fees.
11. I hereby accept that no classes of the TRACKER ACADEMY shall be attended before my official registration and enrolment; held that no learner will be considered for official registration and enrolment before all minimum fees are paid or arrangements have been made with the TRACKER ACADEMY for payment of said fees.
12. If the application is accepted, it will form part of the (my) contract with the TRACKER ACADEMY.
13. I herewith undertake to respect the stipulations of the Copyright Act and indemnify the TRACKER ACADEMY against all claims arising from allegations of the violation of copyright by me as a student.
14. That the agreement arising from the signing of this declaration and application for admission shall notwithstanding the place of signature be deemed to be concluded at Graaff-Reinet.

FULL NAMES AND SURNAME OF LEARNER *

ID NUMBER OF LEARNER *

SIGNATURE OF LEARNER *

Clear Signature

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ANNEXURE F - STATEMENT OF INCOME AND EXPENDITURE

Total number of persons in your household *

Total number of children in your household *

Total number of adults in your household *

Total number of unemployed adults in your household *

Total number of persons contributing to the household income *

INCOME PER MONTH

(total of all persons in your household)

TOTAL INCOME *

MONTHLY EXPENSES

(total of all persons in your household)

TOTAL EXPENSES *

SPECIFY OTHER EXPENSES