SCO – Skipper Coastal Offshore

Enrolment Form
The purpose of this enrolment form is to obtain the information we need to enrol you into a qualification or course at our organisation. We also need to collect information from you which is required by government agencies for statistical and registration reasons. Please fill in the form properly by:
- Completing all sections of the form
- Uploading any additional documentation that is required
You may type your answers directly in the boxes or click the arrow to select your answer from the dropdown menus.
You are enrolling for the following Qualification:

SCO - Skipper Coastal Offshore - New Zealand Certificate in Domestic Maritime Operations (Coastal and Offshore) (Level 5).
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Enrolment Form
You have selected full time study for the SCO - Skipper Coastal Offshore - Certificate in Domestic Maritime Operations, which includes the following courses:
- SCO Competency Preparation
- Plan a Vessel Passage
- Conduct a Vessel Passage
- Meterology
- Watchkeeping and Safety
- Vessel Stability
- Fire Safety
- Sea Survival
- First Aid

Personal Details
Please note that your name, Date of Birth and Residency as entered on this enrolment form will be included in the National Student Index (NSI), and will be used in Authorised Information Matching programmes with official government information, such as the New Zealand Birth Register, to verify the information provided.

The documentation you provide may need to be shared between agencies authorised to access the NSI. For further information please see: http://nsi.education.govt.nz/home.aspx
First Name*
Middle Name
Last Name*
Preferred Name
Names previously known by:
Have you previously enrolled with Skipper Training under another name?

NoYes
What was that name?
Title
Your Date of Birth*

DayMonthYear
Date
Your Gender*
Email*
example@example.com
NSN Number
This is the New Zealand Student Number

Academic Information
What is the name of the last secondary school you attended?*
What was your last year at secondary school?*
What is the highest qualification you hold from a secondary school?*
Your highest achievement may be a “traditional” award such as School Certificate, or you may have achieved a number of credits or a National Certificate at a certain level on the National Qualifications Framework. Your NZQA Record of Achievement shows you the standards, credits and qualifications you have achieved.
Will this enrolment be the first year you have ever enrolled in tertiary studies? (such as Polytechnic’s, Industry Training Organisation’s, University)*

YesNo
Since you answered 'No' above, what was your first year of tertiary study (after school finished)?*
What organisation/s did you study with?*
What subjects did you receive your qualification/s in?*
What is the highest qualification you have achieved since leaving school?*
You may upload copies of other relevant documents here (eg record of learning, qualification certificates).

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Front side of Drivers License*
What is your current NZ visa?
What is your Country of Birth?

Contact Details
Please enter your Personal Information
Your Address*

Street Address

Street Address Line 2

CityRegion

Post CodeCountry
Phone Number*

Pre-FixPhone Number
Emergency Contact Information
Emergency Contact Relationship*
Emergency Contact Name*

First NameLast Name
Email
example@example.com
Phone Number*

Pre-FixPhone Number
Medical Authority and Insurance

In the event of accident or ill health I hereby authorise the full use and disclosure of all information related to my health between all health practioners, All District Health Boards, Skipper Training NZ and all emergency services. I authorise the disclosure of all health information obtained by all health practioners (or their agent) who treats me, to Skipper Training NZ and to my next of kin or emergency contact person. I authorise medical treatment in life threatening situations, should my next of kin or emergency contact person be unavailable or unable to give consent.

I authorise Skipper Training NZ to use and disclose all information obtained by Skipper Training NZ pertaining to my health as Skipper Training NZ determines appropriate.
I confirm i have read and agree to the above medical authority conditions*

Yes
INSURANCE IS A COMPULSORY COMPONENT TO STUDY IN NZ.
Prior to leaving your country you must purchase medical and travel insurance. If you already have medical and travel insurance, please attached a copy of your policy and certification.
Upload Insurance Documents

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Please attach a current photo of yourself (head and shoulders)*

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What is your T-Shirt size*

Declarations
Privacy

Please review our Privacy Policy to understand your rights regarding your personal information, and acknowledge it by ticking the box below.
I have read the Privacy Policy?*

Yes
Fees

In signing this enrolment form you undertake to pay all fees as they become due, and to meet any late fees and collection charges associated with debt recovery. Skipper Training NZ policy on withdrawal and refund of fees can be found in the Student Handbook.
I have read and agree to abide by the fee conditions*

Yes
Fees

In signing this enrolment form you undertake to pay all fees as they become due, and to meet any late fees and collection charges associated with debt recovery. Skipper Training NZ policy on withdrawal and refund of fees can be found in the Supplementary Student Handbook.
I have read and agree to abide by the fee conditions*

Yes
Rules

In signing this enrolment form you undertake to comply with the published rules and policies of Skipper Training NZ. With regard to attendance, academic integrity and progress, conduct and use of information systems.
I have read and agree to abide by the rules and policies of Skipper Training NZ

Yes
Code of Practice 2021

In signing this enrolment form, you acknowledge that you're aware of the Code of Practice and received clear and sufficient information enabling you to make an informed choice about studying at Skipper Training NZ.

Declaration
In signing this form I declare that I have read this form in its entirety and to the best of my knowledge all the information supplied on, and with, this enrolment is true and complete.*

Yes
Date

DayMonthYear
Date
Signature*

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