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For Office Use Only
Enrolment form
Birth Certificate
Clinic Card
Parents Identity Documents
Immigrants: Copy of latest
refugee status in SA
Proof of Residence
Latest School Report
PAROW EAST PRIMARY SCHOOL Grade
Selbourne Street
Parow, 7500
Year
Telephone Number: 0219308655
2016
Class
E-mail: [email protected]
Date:
ENROLMENT FORM
MUST BE COMPLETED IN FULL
LEARNER’S DETAILS:
Surname:
_________________________________________ Male:
Female:
Names in full: ______________________________________________________________________
Residential address: ________________________________________________________________
_________________________________________________________________Code: ___________
Identity Number:
Date of Birth: _________________________
Home Language: English
Afrikaans
Religion: _____________________________
Country of Birth: ___________________________
Other
(Specify) ___________________
Any objection to Religious Instruction: __________
Previous School: __________________________________ Previous Province/Country: ______________
Highest Grade Passed: ______________
Grade Applied For: ______________
Any previous grade repeated? ________________ If so, which grade(s) ___________
Reason for leaving previous school: _____________________________________________________
Other schools attended by learner: ______________________________________________________
Number of children in family: __________
Number of children in Parow East: _______
Position in family: (Circle) 1st, 2nd, 3rd, 4th
Name & Surname of oldest child in Parow East:
MEDICAL INFORMATION:
____________________________________________
Allergies: __________________________________________________________________________
House doctor: ___________________________ Doctor’s Tel. No.: ___________________________
Name of Medical Aid: _________________________ Medical Aid No.: _________________________
Underline sicknesses that learner has had: Measles, Whooping Cough, Mumps, Chicken Pox, German
Measles, Urinary infection, Bilharzia, Meningitis.
Operations that learner has had. Give dates as well: ________________________________________
___________________________________________________________________________________
Against which sicknesses has learner been immunised: (Underline) TB (B.C.G.); BCG; Polio; Measles ;
German measles; Hepatitis B; Diphtheria; Whooping Cough; Tetanus.
PARENT INFORMATION
FATHER:
MOTHER:
SURNAME: _________________________
SURNAME: _________________________
INITIALS: ___________________________
INITIALS: ___________________________
ID NUMBER: ________________________
ID NUMBER: ________________________
MARITAL STATUS: ___________________
MARITAL STATUS: ___________________
POPULATION GROUP: ________________
POPULATION GROUP: ________________
NATIONALITY: _______________________
NATIONALITY: ______________________
TELEPHONE (W): ____________________
TELEPHONE (W): ____________________
TELEPHONE (H): _____________________
TELEPHONE (H): ____________________
CELL: ______________________________
CELL: _____________________________
E-MAIL: _____________________________
E-MAIL: ____________________________
RESIDENTIAL ADDRESS: ______________
RESIDENTIAL ADDRESS: _____________
____________________________________
___________________________________
OCCUPATION: _______________________
OCCUPATION: ______________________
NAME OF EMPLOYER: _________________
NAME OF EMPLOYER: ________________
MEDICAL AID: ________________________
MEDICAL AID: _______________________
GUARDIAN’S DETAILS:
SURNAME: _________________________
INITIALS: ___________________________
ID NUMBER: ________________________
MARITAL STATUS: ___________________
POPULATION GROUP: ________________
NATIONALITY: _______________________
TELEPHONE (W): ____________________
TELEPHONE (H): _____________________
CELL: ______________________________
E-MAIL: _____________________________
RESIDENTIAL ADDRESS: ________________________________________________ ______
__________________________________________________________CODE: ____________
OCCUPATION: _______________________
NAME OF EMPLOYER: _________________
MEDICAL AID: ________________________
MEDICAL AID NO: ____________________
How did you become the Guardian?
Legally
Through a Will
2016 ENROLMENT PROCEDURES
Prospective parents must submit a completed application form on/or before 11 June 2015. For that
matter, enrolment forms (hard copies) for new learners are available at the office during office hours
(07:30 – 15:30).
The application must have certified copies (copy of originals which has been stamped and
signed by the Police or Commissioner of Oaths) attached. No copies will be made at the school
and no originals will be accepted. No enrolment forms for any learners will be accepted without
the learner’s proof of pre-school inoculation. This inoculation is available at any clinic or from
your doctor.
THE APPLICATION FORMS AND CERTIFIED COPIES MUST BE HANDED IN AT THE
SCHOOL. NO ELECTRONIC COPIES WILL BE ACCEPTED.
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Application form
Learner’s Birth Certificate
Clinic or medical card of learner
Copy of both parents or guardians ID’s
Latest school report (if applicable)
Proof of residence. (Copy of proof of address of parents / legal guardian)
Copy of latest refugee status (if applicable)
CEMIS form (for Gr. R, Gr. 1 and learners from other provinces or countries)
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Learners must be enrolled by biological parents or legal guardians.
Transfer card and promotion report (if applicable) must be handed in before learner can be
finally accepted.
Thank you for your co-operation.
J.A. DU PLESSIS
PRINCIPAL