Registration RK2 - Kinderkinetics

Application for FIRST TIME registration as:
KINDERKINETICIST / ASSISTANT KINDERKINETICIST
REGISTRATION FORM: RK2

An amount of R1250 (plus R200 = R1450 for practice registrations only) must be deposited / made out to:
SAPIK
Account number: 9305430937
Branch Code: 632005
ABSA, Tom Street, Potchefstroom.

- Reference: Name, surname, RK2.
- A copy of the deposit slip must accompany the completed form and be e-mailed to sapikinfo@gmail.com / faxed to (018) 299 1825 /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

Last name

First name

Maiden name

Nationality

Ethnic Group

Do you have any disability?

Email address

Initials / Title

Middle name

ID / Passport number

Home Language

Gender

Contact number (w)

Contact number (cellphone)

Physical Address

Province

Postal Address

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

Communicating

Remembering

Hearing

Walking

Self-care

OCCUPATIONAL INFORMATION

Please select one

SAPIK Registration number

Institution of Training

Honors year

EMPLOYMENT INFORMATION

Please select one

Other (Please specify)

PRACTICE INFORMATION
(ONLY FOR PRACTICE OWNERS TO REGISTER THEIR PRACTICES)

Practice/school name:

Location

Practice/school address:

Services: (Please list all programs offered if applicable)

Who works at the practice? (Please list all. If applicable)

TRANSFORMATION QUESTIONNAIRE

Do you think SAPIK requires racial and gender transformation?

Please provide ideas on how to improve SAPIKS transformation status of all races and gender to apply for Kinderkinetics.

How can Universities play a role in transformation?

How can you as a member assist SAPIK’s transformation plan based on gender and race?

I, hereby apply to be registered as Kinderkineticist / Assistant Kinderkineticist 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 Accept / I do not accept (Please select)

Copy of ID Document

Certified copy of results of degree / diploma and/or degree certificate

Certified copy of documentation of practical internship / hours already completed

Copy of the practice/school logo in vector format for our website

Application for FIRST TIME registration as: KINDERKINETICIST / ASSISTANT KINDERKINETICIST REGISTRATION FORM: RK2

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.