Agreement For Services Create PT Agreement For Services Agreement For Services Personal Details First Name * Last Name * Phone * Email * Date Of Birth * Ethnicity * Asian or Asian British Black, Black British, Caribbean or African Mixed or multiple ethnic groups White Other ethnic group Additional Learner Needs? * Yes No Unsure Address * Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Country Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Côte d'Ivoire Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Barthelemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Country Applicant Declaration – Please Read Prior to Signing I confirm that all of the above information is correct and wish to continue under the standard terms and conditions, which I have had an opportunity to read and discuss with the company. In particular, I understand and have discussed the following with the company: 1. I acknowledge that my initial course will start on this day and agree to pay the full amount due in respect of this commitment as set out in the payment schedule agreed. 2. I acknowledge that I will not receive any certification for the course I complete until I have paid for the course in full. 3. I acknowledge that it is my responsibility to complete all the required course content and spend sufficient time revising. It is at the sole discretion of the Create PT assessor whether I pass or not. I acknowledge that if I fail first time I will be able to re-sit the assessments for a second attempt free of charge but any further attempts thereafter will be charged at the current re-assessment charge rate. 4. If your bank fails to make a due direct debit payment from your account, we will write to advise you of this. We may apply to your bank for payment by direct debit twice within one calendar month and we reserve the right to refer any missed due payments to a debt collection agency. Should any course fees not be paid within 30 days of the due date, the full course fee will automatically become due and payable. If course fees are not paid, Create PT may restrict access to learning material and prevent you from completing your course. 5. I acknowledge that the initial deposit I pay is non-refundable and non-transferable. 6. I acknowledge that I have 12 months from the start date to complete my course, at which point access to the learning platform will be revoked. If I do not complete the course within 12 months then I can pay to extend my access in monthly increments at the current extension charge rate. 7. I agree to the payment schedule set out separately with Create PT Applicant Signature * Clear Date * If you are human, leave this field blank. Next Δ