Student Enrolment Form

Thank you for registering with Kaloola Working Holidays, please complete the form, read and review before submitting. Completion of the enrolment form does not guarantee you will be selected to attend the Juckaroo training program.

General Details

Full Name *

Your DOB *

Passport Number *

Country *

Languages Spoken *

Phone Number *

Email Address *

Address in Australia

Address

City

State

Postcode

Forwarding Address (Address in Home Country)

Address

City

State

Postcode

Drivers Details

Do you have a Drivers License
Yes No

License Number

License Expiry

Country of License

Working Visa Details

What type of working visa

Visa Data from

Visa Data to

Do you need sign-off on 2nd year visa
Yes No

Next of Kin

Contact name

Phone Number

Address

City

State

Postcode

Insurance / Medical

Medicare Number

Travel insurance policy number

Allergies / Medical Conditions / Dietary Needs

Kaloola Programs

Which Program are you interested in?
Farm Stay Working Holiday Polocrosse

List all relevant experience

Any additional information / comments

Media Agreement

Yes - I agree thatall photos taken during my stay with Kaloola Working Holidays can be used of Facebook.
I agree that any photos I take will not identify, risk, or deface the image of the properties of KWH on social media.