Surname: ______Name: ______Grade: ______

APPLICATION FORM GROOTE SCHUUR PRIMARY SCHOOL

Please complete the whole form

NO APPLICATION WILL BE ACCEPTED WITHOUT ALL 5 ATTACHMENTS LISTED

The following copies MUST be attached to the Application.

1. S.A.P certified copy of learner’s Birth Certificate [ ] date received______

2. Copy of learner’s latest school report [ ] date received______

3. Copy of learner’s current school fee statement (account) [ ] date received______

4. Copy of Mun Acc or Lease agreement (page with address) as proof of address [ ] date received____

5. Copy of BOTH parents’ ID’s (irrespective of single parent) [ ] date received_____

TO BE COMPLETED BY PARENT/GUARDIAN

GRADE LEARNER IS APPLYING FOR: Gr ______in 20____

Who does the learner stay with: Both parents [ ] Father [ ] Mother [ ] Other: ______

If divorced, state legal guardian: ______

LEARNER’S PARTICULARS

Male/Female? ______Religion: ______Home Language: ______

Date of Birth : ______

D M J/Y

Surname: ______Names: ______ID Nr ______

(On Birth Certificate)

Residential Address: ______Postal Address:______

______Code ______Code ______

Home Language: ______Brother/sister in GSPS______Gr _____

Current School: ______Tel nr: (____)______Fax nr (____)______

Current School email address: (please)______

Reason for leaving: ______

PLEASE DO NOT FAX

OFFICE USE ONLY

1 / Registration Fee paid? Date / 8 / In file to Principal. Date / 15 / Check if deposit was paid
2 / 5 attachments checked? Date / 9 / Comment by principal: / 16 / Add to class list
3 / Fax sent to current school? Date / 10 / Interview date & time: / 17
4 / Back to office “awaiting reply”. Date / 11 / Yes/No / Notes:
5 / Reply received from current school. Date / 12 / Letter to parents Date:
6 / Sent to teacher (______) Date / 13 / Dep of R860 to be paid by
7 / Back from teacher. Date / 14 / Send info: Stationery & Uniform. Date:

FATHER’S PARTICULARS

Title:_____ Name: ______Surname: ______ID NR: ______

Residential Address: ______Postal Address:______

______Code ______Code ______

Phone: (H)______(W) ______(CELL) ______FAX: ______

Occupation: ______Employer: ______

E-mail: ______

MOTHER’S PARTICULARS

Title:_____ Name: ______Surname: ______ID NR: ______

Residential Address: ______Postal Address:______

______Code ______Code ______

Phone: (H)______(W) ______(CELL) ______FAX: ______

Occupation: ______Employer: ______

E-mail: ______

PARTICULARS OF GUARDIAN (if necessary)

Title:_____ Name: ______Surname: ______ID NR: ______

Residential Address: ______Postal Address:______

______Code ______Code ______

Phone: (H)______(W) ______(CELL) ______FAX: ______

Occupation: ______Employer: ______

E-mail: ______

EMERGENCY PHONE NO: ______NAME ______RELATION: ______

MEDICAL AID NAME & NUMBER: ______

I give Permission that Paracetamol or Chamberlains may be administered to my child. YES/NO (Delete not applicable)

Allergies/Illnesses/Comments:______

NAME & ADDRESS OF PERSON RESPONSIBLE FOR SCHOOL FEES:

TITLE: ______INITIALS:______SURNAME:______

ADDRESS (if different from above): ______

______

PHONE: (H) ______(W) ______(C)______

PLEASE DO NOT FAX

MORE ABOUT THE LEARNER:

Name and address of Current/Previous school attended by learner:

______

Current Teacher: ______Tel Nr______Fax nr: ______

Current school email address (PLEASE) ______

Has the learner required remedial, occupational or physio-therapy? YES/NO (if yes, supply details and support material)

______

What sport does learner play? (name all sports): ______

______

What teams did learner play in at previous school? (example U/10B rugby) list all: ______

______

Highest achievement obtained in sport:______

Other interests eg music & choir ______

______

______

______

AGREEMENT:

1. All of the above information is, to the best of my knowledge, true and correct.

2. On acceptance of my child, I undertake to abide by the rules of the school.

3. I record that I am aware of the fact that payment of school fees is compulsory and I declare that I am in a financial position to pay such fees.

Signed at ______on (date) ______

Signature of parent responsible for learner: ______

Signature of parent/person responsible for payment of school fees: ______

Name in PRINT: ______

HAVE YOU COMPLETED THE WHOLE FORM?

HAVE YOU MADE COPIES OF ATTACHMENTS?

HAVE YOU ATTACHED ALL THE COPIES?

REMEMBER R30 REGISTRATION FEE!

PLEASE DO NOT FAX!


OFFICE USE ONLY

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de/2009/AANSOEKVORM 2010

www.gsps.wcape.school.za