Course Registration 2025 – Student Enrolment Given Name * Family Name * Date of Birth * Current Address (as it appears on your ID) * Current Address (as it appears on your ID) Address line 1 Address line 1 Address line 2 Address line 2 City City State State Post code Post code Email * Phone * Course Type * Marine Licence Personal Watercraft (PWC) Endorsement Training Tick both if applicable Course Venue * OnlineBerwickCampbellfieldCoburgDocklandsFerntree GullyGeelongGreensboroughLakes EntranceMilduraMorwellRingwoodWantirna Course Date * Evidence of Identity Type * Photo Drivers Licence/Photo Learner Permit Alternate Evidence of Identity Photo Drivers Licence/Photo Learner Permit Number: * If you do not hold a drivers licence you will be required to provide two forms of ID from the list allowed by Safe Transport Victoria. For you to be eligible for a certificate, Adam’s Boat Course staff must sight the original identification documents detailed on this form. If you cannot demonstrate your residency through your identification you will need to complete a Referee Statement for Evidence of Address form. Primary ID Type * Primary ID Number * Secondary ID Type * Secondary ID Number * Address confirmation eg bank statement Do you have difficulty with language, literacy & numeracy or any other aspect of learning or training? * Yes No Do you give your permission for Adam’s Boat Course to contact you for the purposes of improving training? * Yes No Are you willing to be contacted by Safe Transport Victoria for the purposes of improving course and service delivery? (Your phone and email details will be passed on * Yes No Submit If you are human, leave this field blank.
