HOMEWORK CENTRE APPLICATION FORM

 

 

 

 

Year applying for

 

New Child Re-Admission
Homework Centre    

 

School attending Grade

 

Date on which  admission required

 

DETAILS OF CHILD/REN

Surname
Name
Preferred name
Gender          
Nationality  
Date of birth Year:   Month: Day:       
Age
ID Number
Home language
Physical address
Previous School
Period at School

PARTICULARS OF PARENTS / GUARDIAN

FATHER

Surname
First Name
ID Number
Home address
Postal Code
Postal address
Postal Code
Contact Details
  H  
  Cell
Email address
Occupation
Name of Employer
Contact number

MOTHER

Surname
First Name
ID Number
Home address
Postal Code
Postal address
Postal Code
Contact Details
  H  
  Cell
Email address
Occupation
Name of Employer
Contact number

MARK (X) WHERE APPLICABLE

Father Mother
Own Father

Divorced stay with Father Own Mother Divorced stay with Mother
Step Father Single Parent Step Mother Single Parent
Widower Stay with grand mom/dad Widow Stay with grand mom/dad
Guardian Stay with uncle/aunt Guardian Stay with uncle/aunt
Forster care Children's home Forster care Children's home

 

MEDICAL INFORMATION

Medical Doctor
Contact number
Medical aid
Medical No
Previous sickness
Allergies
Chronic medication

 

PERSON RESPONSIBLE FOR SCHOOL FEES

Surname
Name
ID Number
Email address

 

IN CASE OF EMERGENCY

Name of next of kin
Surname
Address
Contact Details
  Cell
Relationship
 

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