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Registration form RK2
Application for 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
Initials / Title
Mr
Ms
Mrs
Dr
Prof
First name
Middle name
Maiden name
ID/Passport number
(Required)
Nationality
South African
Namibian
Other
Home Language
Afrikaans
English
Tswana
Xhosa
Zulu
Ethnic Group
White
Black
Coloured
Indian
Gender
Male
Female
Do you have any disability?
First Choice
Second Choice
Third Choice
Contact number (w)
Email
(Required)
Contact number (cellphone)
Physical Address
Postal Address
Province
(Required)
Eastern Cape
Free State
Gauteng
KwaZulu-Natal
Limpopo
Mpumalanga
Northern Cape
North West
Western Cape
Other
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
1
2
3
4
5
6
7
Hearing
1
2
3
4
5
6
7
Communicating
1
2
3
4
5
6
7
Walking
1
2
3
4
5
6
7
Remembering
1
2
3
4
5
6
7
Self-care
1
2
3
4
5
6
7
OCCUPATIONAL INFORMATION
Please select one
(Required)
Kinderkineticist
Assistant Kinderkineticist
Institution of Training
(Required)
North-West University
Stellenbosch University
University of Free State
Honors Year
(Required)
EMPLOYMENT INFORMATION (ONLY FOR PRACTICE OWNERS TO REGISTER THEIR PRACTICES)
Please select one
(Required)
Employer (Owner of a practice)
Working at a Training Institution
Appointed at a school
Employee (Working at a practice)
Other
Location
(Required)
SOCIAL MEDIA PAGE LINK (Facebook or Instagram)
(Required)
Other (Please specify)
(Required)
PRACTICE INFORMATION (ONLY FOR PRACTICE OWNERS TO REGISTER THEIR PRACTICES))
Practice/school name:
(Required)
Practice/school address:
(Required)
Location
(Required)
SOCIAL MEDIA PAGE LINK (Facebook or Instagram)
(Required)
Services: (Please list all programs offered if applicable)
(Required)
Who works at the practice? (Please list all. If applicable)
(Required)
TRANSFORMATION
Do you think SAPIK requires racial and gender transformation?
Yes
No
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)
Accept
Do not accept
Copy of ID Document
Max. file size: 128 MB.
Certified copy of results of degree / diploma and/or degree certificate
Max. file size: 128 MB.
Certified copy of documentation of practical internship / hours already completed
Max. file size: 128 MB.
Copy of the practice/school logo in vector format for our website
Max. file size: 128 MB.
