Application For Admission To School 2022

Application For Admission To School 2022

P.O.Box 129, Thokoza, 1421 Physical address: 774 Umbrella Street, Greenfields Tel: 011 904 4400/904 4300/904 4200 Email: info@greenfields.co.za www.greenfields.co.za NOTE: This form must be completed in full. All changes to be initialed or signed by parent/guardian. Completing this form does not necessarily mean that the learner has been accepted into the school.

Grade Applied For

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Highest Grade Passed

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Year when grade was passed

Accession No.

Surname

Initials

Nickname

First Name

Other names

Date Of Birth: YYYYMMDD

Gender

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Race

Identification Number:

Country Of Residence

Citizenship:

If SA indicate province of residence:

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Physical Address:

Telephone Number

Emergency Number

City/Suburb:

Learner Cell:

Code:

Learner Email Address:

Home Language:

Preferred language of Instruction:

Boarder:

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Deceased Parent:

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Mode of transport:

Religion:

For Grade 1 only: Indicate pre-primary education

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PREVIOUS SCHOOL INFORMATION

Name of previous school:

Previous school address:

Code

Province

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Country

LEARNER MEDICAL INFORMATION

Medical Aid Number:

Medical Aid Name:

Medical aid main member:

Doctor Name

Doctor's Address

Doctors Telephone number

Medical Condition:

Special Problems requiring Counselling:

Dexterity Of Learner

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Reg. Social Grant

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Rec. Social Grant (1)

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IF THE LEARNER IS ACCEPTED, THE FOLLOWING DOCUMENTS MUST BE SUBMITTED TO THE SCHOOL: 1. Copy of immunisation records. 2. Copy of Birth Certificate. 3. Progress report from previous school. 4. Transfer letter from previous school.

SIBLINGS

Number of children in school

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Position in the family (e.g. First)

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Name:

Grade

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Name: (1)

Grade (1)

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Name: (2)

Grade (2)

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PARENT / GURADIAN INFORMATION

Complete a SEPERATE parent form for each parent living at a different physical address.

Title:

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Initials:

Surname:

1.1) First Name:

Gender (1)

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Home Language: (1)

Race:

ID Or Passport

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Identification Number Or Passport Number:

Account Payer

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Residential Street Address:

Code: (1)

City/Suburb

Code (1)

Occupation:

Employer:

Surname of Spouse:

First Name:

Occupation of Spouse:

Learner resides with this Parent/s

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Spouse ID Number:

Relationship to Learner:

Marital status of Parent:

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CORRESPONDENCE DETAILS

Title: (1)

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Surname: (1)

Postal Address:

City/Suburb (1)

1.1, CODE

OTHER CONTACT DETAILS

Home Telephone:

Work Telephone

Fax Number:

Cell phone Number:

Spouse Work Telephone

Spouse Cell phone Number:

E-mail Address:

Spouses E-mail:

DECLARATION

I HEREBY DECLARE THAT TO THE BEST OF MY KNOWLEDGE, THE ABOVE INFORMATION AS SUPPLIED IS ACCURATE AND CORRECT

NAME OF PARENT / GUARDIAN

Signature Tick Box

DATE

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