ADMISSION FORM CHILDS DETAILSFirst Name *Last Name *Date of Birth *ID Number *Grade at Entry *Age at Entry *Gender *MaleFemalHomeschooling Curriculum Chosen *UCT Online High SchoolMos-WêreldwydAuxilioBrainlineImpaqTHINK Digital CollegeKoa AcademyASDANHomework CareFATHER / GUARDIAN DETAILSFirst Name *Last Name *Date of Birth *ID Number *Phone *Email Address *Street Address *City *ZIP / Postal Code *MOTHER / GUARDIAN DETAILSFirst Name *Last Name *Date of Birth *ID Number *Phone *Email Address *Street Address *City *ZIP / Postal Code *MEDICAL AND HEALTHDoes your child take regular medication? *YesNoIf yes, please specify *Are there any special medical, physical or emotional needs that the centre should be aware of? *YesNoIf yes, please specify *Is your child potty trained? *YesNoIn the event your child is ill or injured and we cannot get hold of you we will take your child to the local doctor? You will be liable for all the associated charges *YesBILLING INFORMATIONPerson responsible for payment of fees (NB: The parents are ultimately responsible for payment of the fees, even if somebody else has undertaken to pay them and defaults)Is person responsible for payment of fees different from parents /guardian? *YesNoFirst Name *Last Name *Date of Birth *ID Number *Phone *Email Address *Street Address *City *ZIP / Postal Code *SIGNATURESPARENTS / GUARDIANFirst Name *Last NameSignatureID Number *Date Signed *Consent *Yes, I agree with the terms and conditions.Send Message
