Relationship to Applicant Clause Samples

Relationship to Applicant. Parent/Legal Guardian’s signature: I have read, and agree to, all the contents set out on the reverse of this agreement & the fee structure on this page of the agreement and acknowledge full responsibility to the terms and conditions stated herein as required for membership. AGREEMENT Student reference no: Dojo Code: Dojo:

Relationship to Applicant. 1. Please describe the student’s work ethic and goals. 2. Describe any challenges or obstacles the student has overcome. 3. How have you seen this student helping others (school, home, and/or in the community)? 4. Is there anything else you wish to share?

Relationship to Applicant. CELL PHONE ALTERNATE PHONE

Relationship to Applicant. Date: I authorize the professional who has completed Section II of this application to release to GoWake Access, information about my disability or health condition and its effect on my ability to travel on the GoApex transit system. I understand that I may revoke this authorization at any time. I, the applicant, understand that the purpose of this application is to determine my eligibility to use the GoApex Door to Door services. I agree to release the information requested to GoWake Access and any eligibility review panel and understand that the information contained herein will be treated confidentially, unless otherwise required by law. I understand further that GoWake Access reserves the right to request additional information at its discretion. I agree to notify GoWake Access of any changes in the status of my disability that affects my ability to use the GoApex Door to Door services. I also understand that this may affect my eligibility as a rider. Applicant’s Name: Date of Birth: Applicant’s Physical Address: City State Zip: Applicant’s Mailing Address: City State Zip: Applicant’s Telephone Number: Applicant’s Signature Date: Applicant Name

Relationship to Applicant. Email: Full Name: Phone: Address: COURSE DETAILS Course Type Start Date End Date Weeks/Hours □ General English - Day Class □ Full-time □ Part-time dd/mm/yy dd/mm/yy □ General English - Night Class □ Full-time □ Part-time □ IELTS Preparation □ Full-time □ Part-time □ PELT - General English □ PELT - IELTS Preparation □ PELT - Tailored English Tutoring □ VIP 1-1 □ VIP 1- 2 □ PTE Training Course □ Tailored English Tutoring □ Duolingo Training Course □ IELTS Exam Skill Course Do you have any medical condition(s), disabilities, long-term illnesses, or specific learning needs that need to be taken into consideration by the institute? □ Yes (Please provide details below) □ No ACCOMMODATION Do you require assistance with accommodation? □ Yes (Please contact us to discuss your requirements) □ No, I will organise my accommodation myself Do you want Zealive Institute of New Zealand to pick you up from the airport? □ Yes (Please provide your flight details below) □ No Airline: Flight Number:

Relationship to Applicant. Property: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .