APPLICATION FOR ADMISSION TO SCHOOL
 
(OFFICE USE ONLY)
 
ADMISSION NO: ................................... HOUSE: ................................... GRADE: ................................... YEAR: ...................................

LEARNER
 
Surname: ................................... Full Names: ...................................
Sex: ................................... Identity No: ................................... Home Lang: ...................................
Date of Birth: ................................... Place of Birth: ...................................
Learner is 1st, 2nd, 3rd, etc in family: ...................................
Latest school attended (Gr.1 applicants please state pre primary): ...................................
Other school (s) attended: ................................... Gr. Passed ................................... Year: ...................................
Residential Address: ...................................  Code ...................................

FATHER
 
Surname: ................................... Full Names: ...................................
Address: ................................... Postal Code: ...................................
Tel No. (W): ................................... Home: ................................... Cell: ...................................
Employer: ................................... Occupation: ...................................
Self Employed: ................................... ID or Passport no: ...................................
NATIONALITY: FATHER: ...................................
Name and Type of Business: ...................................

MOTHER
 
Surname: ................................... Full Names: ...................................
Address: ................................... Postal Code: ...................................
Tel No. (W): ................................... Home: ................................... Cell: ...................................
Employer: ................................... Occupation: ...................................
Self Employed: ................................... ID or Passport no: ...................................
NATIONALITY: FATHER: ...................................
Name and Type of Business: ...................................
 
In case of single/divorced parent families only, please complete
 
Which parent has legal custody? .....................................
Full Name of Stepfather / Stepmother (if applicable) .....................................
Tel No of Stepfather or Stepmother: (w) ..................................... Cell: .....................................
mergency (Alternate) Contact Person: ..................................... Tel No: .....................................
(State relationship, e.g. grandparent, neighbour, etc): .....................................
 
MEDICAL DETAILS
 
Medical Aid: ...................................... Membership No: ......................................
Principal Member: ...................................... Doctor: ......................................
Tel No: ......................................
Any allergies or medical conditions or other information the school should be aware of or know about: ......................................
Underline illness (es) learner has had: Measels, German Measels, Whooping Cough, Chicken Pox, Mumps.  
Other illness (es) from which the learner is suffering (e.g.  Asthma, Epilepsy etc): ......................................
 
RELIGION
 
If Catholic, please complete this section.  
Date of Baptism: ................................................
   
If not, please complete this section.  
Date of First Holy Communion: ................................................
Religion: ................................................
   
RELIGIOUS INSTRUCTION:  
Have you Parent/Guardian of the above – mentioned learner any conscientious objection to his / her being present when instruction in Religious Education is given as laid down in the Education Ordinance, 1956, as amended?  (YES/NO)
 
FINANCIAL INFORMATION
 
Name of Person responsible for account: ........................................................................................
Bank Details: ........................................................................................
Name Of Account Holder: ........................................................................................
Name Of Bank: ........................................................................................
Branch Code: ........................................................................................
Account No: ........................................................................................
Reference:  Name of Learner: ........................................................................................
 
UNDERTAKING BY PARENTS /GUARDIANS:
 
In the event of this application being successful, We/I as parent(s) guardian(s) acting on behalf of my /our child undertake the following and sign it as a written agreement I the presence of the Principal or a delegated member of staff.

To accept and uphold the vision, mission statement and code of conduct of St Agnes’ Primary School, and to do my best to ensure that my /our child /children does the same.

To ensure that he/she attends school punctually and regularly.

To ensure that my child/children wears the correct school uniform (Summer and Winter).

To pay the required school fees regularly.

To attend parent meetings and participate in the community life of the school when possible.

Father: ............................................. Mother: ............................................. Guardian: .............................................
Principal or delegated staff member: ............................................. Date: .............................................
 
(FOR OFFICE USE)
 
1.  Transfer documents received/requested
2.  Latest school report received/requested
3.  Birth Certificate received/requested
4.  Baptism Certificate received/requested
5.  Clinic card received/requested
6.  Immigration documents received/requested
7. Certified copies of Parents/Guardians ID documents received/requested
8.  Most recent payslip received/requested
9.  Three month Bank Statement received/requested
10.  An original FICA /IT34 (CCT Account) Proof of address received/requested
11. If you are the official guardian, please hand in a certified copy of the official document. received/requested
12. Immigrants / Refugees, please attach certified copies of Home Affairs documents received/requested
13. Parent or Guardian’s Legal Status received/requested
14. Are the learners parents residing in SA Yes / No