REGISTRATION FORM: RK1
 

Application for registration as:

KINDERKINETICIST / ASSISTANT KINDERKINETICIST

  * Fields are mandatory
   
 

An amount of R1100.00 must be deposited / made out to:

SAPIK – account number: 9305430937, Branch Code: 632005, ABSA, Tom Street, Potchefstroom. Reference: Name, surname, Reference: RK1.

A copy of the deposit slip must accompany the completed form and be e-mailed to the above email address or faxed to (018) 299 1825 or hand delivered to the office.

   
  *
     
  Last name:
  First:
  Initial:
  Title:
  Marital status:
  Maiden name:
  Identity number / Passport:
  Nationality:
  Address:
 
  Ethnic group:
     
  Gender:
 
   
  *
     
  Telephone number:
  (Home):
  (Work):
  (Cellphone):
  E-mail address:
     
  Occupation:
     
 
   
  Other (please specify):
 
   
 
     
  SAPIK registration number:
  Institution of training:
  Honors year:
  Employment:
     
  If your practice details change please complete the following fields
     
  Practice name:
  Region:
  City/Town:
  Contact details:
  Service delivery:
     
   
 

Please note that it is your responsibility to inform SAPIK of the change

   
   
 

Please attached:

  • Proof of payment
   
  Please Upload your Proof of payment below:
 
   
   
 

Declaration:

I, hereby apply to be registered as Kinderkineticist / Assistant Kinderkineticist at SAPIK and declare that all information provided (including copies) is completed and correct. I also declare that I have read and understand the updated Ethical Guidelines of SAPIK, and that I agree to abide by these rules and regulations. I accept responsibility to keep updated with any changes made regarding the guidelines.

   
  Signature:
 
   
  Date:
  --
   
 
Security Check: