Admission Form

Note: This form must be completed in FULL. All changes to be initialled or signed by parent/guardian. Completing this form does not necessarily mean that your child has been accepted into the school. Your application is COMPLETE only when all the required supporting documents and proof of payment of a non-refundable fee of R150.00 have been received.

Grade:*

Year:*

PUPIL INFORMATION

Surname:*

First Name:*

Date of Birth:*

Gender:*

ID Number:*

Religion:*

Home Language:*

Country of Residence:*

Citizenship:*

Province of residence:*

Dexterity of Learner:*

CURRENT SCHOOL INFORMATION

Name of Current School:*

Telephone Number:*

Current School Address:*

Email Address:*

Code:*

Province:*

Country:*

PUPIL MEDICAL INFORMATION

Medical Aid Number:*

Medical Aid Name:*

Medical Aid Main Member:*

Doctor Name:*

Doctor’s Address:*

Doctor Tel No:*

Medical Condition:*

Special Problems Requiring Counselling:*

I certify that the above particulars are correct:*

PARENT INFORMATION

FATHERS INFORMATION

Surname:*

First Name:*

ID Number:*

If not South African Citizen Please Fill in block Below

Nationality & Passport NO.:

Work Number:*

Cell Number:*

Home Number:*

Email:*

Home Address:*

Postal Address:*

Occupation:*

MOTHERS INFORMATION

Surname:*

First Name:*

ID Number:*

If not South African Citizen Please Fill in block Below

Nationality & Passport NO.:

Work Number:*

Cell Number:*

Home Number:*

Email:*

Home Address:*

Postal Address:*

Occupation:*

Non-refundable R150.00 Application Fee is due upon submission of this form. Please attach proof of payment using name of child 2018.