Student Living CPT

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Student Living CPT

Email *

Record my email address with my response

Student Information

This is the information of the student who will be staying with us.

Full Name *

Date of Birth *

YYYY

Age *

Gender *

Male

Female

Other:

Required

Nationality *

Passport/ID Number *

Current Address *

Email Address *

Mobile Number *

Landline Number

Medical Information

This is medical the information of the student who will be staying with us, please include any and all important medical information

Medical Conditions *

Allergies *

Medical Aid *

Medical Aid Contact Details *

Medical Aid Number *

Any Other Medical Info

Emergency Contact/Next of Kin

Emergency Contact Full Name *

Relationship To Student *

Emergency Contact Citizenship *

Emergency Contact Address *

Emergency Contact Mobile Number *

Emergency Contact Email Address *

Study Information

School Enrolled *

Student Number *

Program *

Duration of studies *

Accommodation Requirements

Room *

Single Private Room

Twin Shared Room

Check-In Date *

YYYY

Check-Out Date *

YYYY

Breakfast Included *

Yes

Bar Fridge (In Room) *

Yes

Parking Space *

Yes

Do you smoke? *

Yes

Conditions of Booking

Rooms are allocated on a first-come-first serve basis.
Booking confirmation by payment, 4 weeks in advance.
Payments should be made via EFT, to be cleared 14 days prior to check in date.
All applicants are required to sign a tenancy agreement & ho(s)tel rules.

I understand and accept the general conditions for booking of ho(s)tel accommodation.

I declare that the particulars in the application form are true to the best of my knowledge, and I have not wilfully suppressed any material fact. Any misrepresentation or omission of information will render me ineligible for student accommodation.

I undertake to abide by the tenancy agreement and ho(s)tel accommodation code of conduct.

I hereby acknowledge that I have read & understood the house rules. I agree to comply with them & accept the consequences in the event of any infractions.

I agree

Other:

Signature (Print name) *

Date Completed *

YYYY

Send me a copy of my responses.

Submit

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