Application Form

Application Form For Grade R – 12

Page 1 of 3

Personal Information

Grade Applied For

Highest Grade

Year Grade Passes

Accession No

Name

Title

First

Middle

Surname

Initials

Date of Birth

Race*

Country of Residence

If SA, Indicate Province of residence

Other Names

Gender

ID/Passport

Citizenship

Previous School Information

Name of Previous School

Previous School Address

Zip Code

Province

Country

Siblings

Siblings information if any

Name

First

Last

Grade

Name

First

Last

Grade

Name

First

Last

Grade

Untitled

Medical Aid Number

Medical Aid Main Number

Doctor's Address

Medical Condition

Dexterity of Learner

Untitled

Medical Aid Name

Doctor's Name

Doctor's Telephone Number

Reg. Social Grand

Rec. Social Grand

Address Information

Address

City/Suburb

Code

Home Telephone

Energency Telephone

Learner Cell

Email Address

PARENT / GUARDIAN INFORMATION

Name

Salutation

First

Intials

Surname

Gender

Home Language

Race

ID/Passport

Account Payer

Yes

City/Suburb

Occupation

Surname of Spouse

Occupation of Spouse

Spouse ID/Passport

Code

Employer

Spouse First Name

Learner resides with this parent/s

Yes

Relationship to Learner

Marital Status

Home Telephone

Fax Number

Spouse Work Telephone

Email Address

Work Telephone

Cell Number

Spouse Cell Number

Spouse E-Mail Address

Please upload your supporting documents as listed in the admissions page. You can upload up to 10 supported documents of type (pdf, docx, doc, jpg, tif). Total upload size should not exceed 10mb

Upload

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12 Goldman Street

+27117493168

Mon - Fri: 7:15 - 16:00