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REGISTRATION FORM: RK3
 

Application for registration as:

KINDERKINETICIST IN TRAINING / ASSISTANT KINDERKINETICIST IN TRAINING

An amount of R160 must be deposited / made out to:
SAPIK – Account number: 9305430937, Branch Code: 632005, ABSA, Tom Street, Potchefstroom.
Reference: Name, surname, RK3.
A copy of the deposit slip must accompany the completed form and be e-mailed to sapikinfo@gmail.com or hand delivered to the office.


The following registration form must be completed in full. Take note that SAQA require specific
information each year. In order to obtain that information, you need to complete all sections of this
form. If this document is incomplete, your registration will not be successful and a fine will be
applicable after March of each year

  * Fields are mandatory
  * PERSONAL INFORMATION
     
  Last name
  Initial
  Title
  First name
  Middle name
  Maiden name
  ID/Passport number
  Nationality
  Home language
  Ethnic group
  Gender
 
     
  * Physical address
   
 
   
  * Postal address
   
 
   
  *
     
  Province
  Email address
     
  * Cellphone numbers
 
   
  * Do you have any disability (If yes, elaborate)?
   
 
   
  * Rate yourself according to the following: Indicate the correct number next to each question. 1. No difficulty; 2. Some difficulty; 3. A lot of difficulty; 4. Cannot do at all; 5. Cannot be determined, 6. May be part of multiple difficulties, 7. May have difficulty, 8. Former difficulty - none now. For example. Seeing = 2
     
  Seeing:
  Hearing:
  Communicating:
  Walking:
  Remembering:
  Self-care:
     
  * OCCUPATIONAL INFORMATION
     
  Kinderkineticist in Training
  Assistant Kinderkineticist in Training
   
  *
     
  Institution of Training
  Year of Training
  Program leader (Name and surname)
     
   
 

DECLARATION:
I, hereby apply to be registered as Kinderkineticist in Training / Assistant Kinderkineticist in Training 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.

   
  * I agree
     
  Yes
   
  * Date
 
   
   
 

Please attach:
- Proof of payment
- Assignment: Ethical guidelines

   
  * Upload your proof of payment here
 
   
  * Upload your assignment here
 
   
 


 
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