APPLICATION FORM

Please complete the form below and upload the required documents.

Application Details

Requested Starting Date *

Group *Select GroupBaby ClassToddler ClassGrade RRGrade R

Learner Information

First Name of Child *

Surname of Child *

Sex of Child *BoyGirl

Date of Birth *

Home Language *

Has the child attended a playgroup before? *YesNo

Who does the child live with? *

Father Information

Father's Full Names *

Identity Number *

Residential Address *

City

Province

Postal Code

Telephone Number Work *

Telephone Number Home *

Cell Phone Number *

Employer *

Position *

Email Address *

Mother Information

Mother's Full Names *

Identity Number *

Residential Address if different from Father *

City

Province

Postal Code

Telephone Number Work *

Telephone Number Home *

Cell Phone Number *

Email Address *

Emergency Contact (If parents cannot be reached)

Emergency Contact Name *

Telephone Number *

Relationship *

Emergency Contact Name *

Telephone Number *

Relationship *

Emergency Contact Name *

Telephone Number *

Relationship *

Medical Questionnaire

Medical Aid

Main Member

Main Member ID Number

Medical Aid Number

Doctor Name

Doctor's Number

Doctor Address

City

Province

Postal Code

CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint HelenaSaint Kitts and NevisSaint LuciaSaint Pierre & MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemenZambiaZimbabwe

Does your child have any allergies or illnesses? *YesNo

If yes please explain

What medication is required to manage the allergy or illness?

Is your child on any medication? *YesNo

If yes please explain what medication and when it is administered

Is there anything else regarding your child's health that we need to know?

Required Documents

Child's Birth Certificate *Upload a copy of the child's birth certificate

Choose FileNo file chosenDelete uploaded file

Child's Clinic Card *Upload a copy of the clinic card

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3 Months Bank Statement or 3 Months Payslip *Upload the latest 3 months bank statement or payslip

Choose FileNo file chosenDelete uploaded file

Parent Declaration

Parent Full Name *

Date *

Submit