Dear Parent

ENROLMENT

Complete the application form and attached the documents as requested below and

submit application at the office.

Attached the following:

1.  Copy of the child’s Birth certificate

2.  Copy of both parents I D document

3.  Copy of child’s Clinic Card (page showing immunizations)

4.  Copy of last report received (not for Gr R & 1 applications)

5.  Copy of proof of home address

6.  Administration fee – R50

All applications must be submitted at the office.

Yours faithfully

EXCELSIOR PRIMARY SCHOOL: PRINCIPAL

Website: www.exprim.co.za

APPLICATION FOR ADMISSION TO EXCELSIOR PRIMARY SCHOOL

GRADE / YEAR

A

LEARNER Surname
LEARNER Full First Names
With whom does the child reside?
I.D. Number (on Birth Certificate)
Gender (Male / Female)
Home language
Additional language
Religious affiliation
Name of last school attended
Highest grade passed
(Attach a copy of the latest examination results)
Reason for leaving
Do you have any other children in this school.
(State names and grades)
Does the learner suffer from any allergies or Chronic ailments?
Has the learner been immunized (supply clinic card)
Has the learner undergone any operations? (specify)
Doctor / Tel. no.
Medical Aid
Membership no.

B

PARTICULARS OF PARENT(S) OR GUARDIAN(S)
FATHER / GUARDIAN / MOTHER / GUARDIAN
Title / Title
Surname / Surname
Initials / Initials
I.D. Number / I.D. Number
Residential
Address / Residential
Address
Tel. (Home) / Tel. (Home)
Tel. (Work) / Tel. (Work)
Cell / Cell
E mail address / E mail address
Occupation / Occupation
Employer and / Employer and
Address / Address
Other contact / Other contact

C

PAYMENT OF SCHOOL FEES
Ø  All payments must be made via EFT. Details available at the office.

D

UNDERTAKING AT ADMISSION OF LEARNER
The following learner,……………………………………………………………………………………………, has applied for admission to the school.
Should the following learner be admitted to this school, the undertaking below will be viewed as binding.
I, (father / mother / guardian)………………………………………………………………,.undertake the following on behalf of my child.
1.  Permission is hereby granted for my child to make use of transportation as organized by the school for any bona fide school-or sporting activities without the transport company, educators or Governing Body being held in any way responsible for any claims which might arise, unless proof of negligence is evident.
2.  Timeous and regular school attendance.
3.  Participation in co-curricular activities will be encouraged.
4.  The acceptance of all authoritarian structures as set out in the school’s Code of Conduct and general day to day administration.
5.  Recognition of and abiding by the school’s Code of Conduct.
6.  All financial obligations towards the school will be met timeously.
7. My child will wear the school’s official uniform as set out in the prospectus.
8. I hereby grant permission that, should I/we as parents not be contactable immediately, my child be allowed medical assistance of the best possible nature if the principal or responsible educator feels it in my child’s best interest to do so.
I hereby indemnify the above school from any actions which might arise as a result of this.
……………………………………………………………… ………………………………..
PARENT / GUARDIAN DATE

E

DECISION ON ADMISSION OF A LEARNER (Office use only)
…………………………………………………………admission into Gr …… has been accepted / rejected.
Reason for rejection …………………………………………………………………………………………………….
Interhouse group: …………………………….
______
PRINCIPAL DATE