HOËRSKOOL MIDDELBURG

Private Bag X251811 Tel : 013 282 7393/4/5E-mail:

MIDDELBURG 1050Fax: 013 282 4402Web page:

APPLICATION FOR ADMISSION FOR THE YEAR2018

GRADE ______

This form must be completed by one of the parents, and not by the learner. Please print and complete the application in ink. Circle where necessary and delete what is not applicable. New application only: Closing date for applications: 30 June 2017. Should you receive no response by 31 July 2017, the onus is on you to inquire.

New applications only

Previous school: Town / city:
Reason why the learner left the previous school. (If the previous school was a secondary school.)
Highest grade passed: (Attach a copy of the latest examination results)
Grade/s which the learner has already repeated (if any)

I bind myself to submit copies of the following accompanying documents with the application and understand that no application will be accepted without any one of the documents listed below. If the parents’ surnames differ in their ID documents, a marriage certificate must be attached.

  • Learner’s birth certificate
  • I.D. documents of BOTH PARENTS
  • The most recent Water and Lights account
  • The most recent examination results/academic report of the previous school
  • Transfer certificate/documents
  • Proof of achievements (when applicable)

______Signature of Parent

Surname of learner: Male Female

Full names:

Name known by: Present grade:
IDENTITY NUMBER:

The Departmentof Education requires that parents, who want their children to attend the same school during the following year, re-apply for admission at the end of each year.

Today's date (DD / MM / YYYY)

I, (Mr. Mrs.) ______the father / mother / legal guardian of the above named child, request that he / she be admitted / re-admitted as a learner of Hoërskool Middelburg. If legal guardian proof of guardianship required.

Is this a request for re-admittance? YES / NO
If so, in which class is
the pupil at present? / What is your school
fees account number?

This learner's position in the family (e.g. 2/3) (2nd child from 3) ______

Page 2

Learner resides with / Own father and own mother / Mother
(single parent) / Father
(single parent) / Mother and
stepfather / Father and
stepmother / Grandparent / Other family / Other persons

OTHER LEARNERS IN HOËRSKOOL MIDDELBURG (NAME AND GRADE)

Have you also applied for hostel accommodation for this learner? YES / NO

NB. If YES take note that a separate agreement for hostel accommodation is to be concluded with the school. A copy of the agreement is available at the administration office at the school.

A. DETAILS OF THE PERSON WHO IS RESPONSIBLE FOR THE PAYMENT OF THIS LEARNER’S SCHOOL FEES
Relation to this pupil: (Please encircle)
Father / Mother / Stepfather / Stepmother / Grandfather / Grandmother / Uncle / Aunt / Foster parent / Other (details please)
TITLE, INITIALS AND SURNAME
FULL NAMES
RESIDENTIAL ADDRESS
POSTAL ADDRESS
OCCUPATION
NAME OF EMPLOYER
STREET ADDRESS OF EMPLOYER
POSTAL ADDRESS OF EMPLOYER

TELEPHONE

/ WORK / HOME
CELLULAR / FAX
E-MAIL / ID NUMBER

Page 3

B. DETAILS OF THE OTHER PARENT / GUARDIAN
Relation to this pupil: (Please encircle)
Father / Mother / Stepfather / Stepmother / Grandfather / Grandmother / Uncle / Aunt
Foster parent / Other (details please) ______
TITLE, INITIALS AND SURNAME
FULL NAMES
RESIDENTIAL ADDRESS
POSTAL ADDRESS
OCCUPATION
NAME OF EMPLOYER
STREET ADDRESS OF EMPLOYER
POSTAL ADDRESS OF EMPLOYER

TELEPHONE

/ WORK / HOME
CELLULAR / FAX
E-MAIL / ID NUMBER
C. FAMILY OR FRIEND WHO CAN BE CONTACTED IN AN EMERGENCY
Relation to this learner: (Please encircle)
Brother / Sister / Grandfather / Grandmother / Uncle / Aunt / Neighbour / Friend of
the family / Other (details please) ______

TITLE, INITIALS AND SURNAME

RESIDENTIAL ADDRESS

TELEPHONE

/ WORK / HOME
CELLULAR
RELIGION / DENOMINATION
DOCTOR / MEDICAL AID
NAME OF MEMBER / MEDICAL AID NO

Page 4

SCHOOL FEES

According to the SA Schools Act, a parent or guardian who enrol a learner in a public school is legally obligated to pay the prescribed school fees. School fees are determined annually by the elected Governing Body, after drawing up a budget for the following year.

Please note some parents may, based upon the combined gross salary of both parents, qualify and apply for a partial or full exemption of school fees. Details of the criteria, the application procedure as well as the sliding scale, can be obtained from the school. Applications for a subsidy must be handed in before

31st of January of each year. The parent remains responsible for the payment of all school fees until the application is approved.

The closing date for once off payments is on the end of February. Should you choose the option of monthly instalments, the school fees is payable in 10 monthly payments, payable from January.

While a reasonable period is given for payment of school fees, the full amount will become due and payable if the parent falls behind with payments. This means that the full amount that was levied for the year, plus interest will be handed to the school’s legal advisors for collection.

The school will not discriminate against any child on the grounds of the non-payment of fees by the parents, but parents should take notice of the following:

If payments are not made in time, I agree to pay interest which will be levied within the framework of existing financial legislation. Should non-payment of school fees be handed over for collection to the school’s legal advisors, I accept liability for payment of legal fees on the scale as between attorney and client as well as collection commission. I also agree that if this should happen, an amount equal to the monthly payment may be collected from my employer.

It is hereby specifically agreed that the school shall be entitled to, at its sole discretion, to allocate any payment made towards such debits or outstanding amounts as the school may determine.

The responsible parent agrees that, if this should happen, an amount equal to the monthly payment may be collected from his employer.

I take notice of the conditions mentioned above
(Signature of parent)

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PAYMENT OF SCHOOL FEES

Please select ONE of the following four options. Only that option’s details should be completed. Please sign your name in the space provided.

I PREFER TO RECEIVE MY ACCOUNT VIA EMAIL:
My email address is:
OPTION 1 ONCE OFF PAYMENT

I undertake to pay the full amount before the end of February

A discount will be given
SIGNATURE:
OPTION 2 MONTHLY PAYMENT

I would like to pay the school fees in 10 equal payments from January until October

SIGNATURE:
OPTION 3 CONTINUATION OF DEBIT ORDER
I currently use a debit order to pay my account with Hoërskool Middelburg, and would like it to continue.
SIGNATURE:
If you have changed to another or the number of your bank account has changed,
please complete option 4 as well.
OPTION 4 NEW DEBIT ORDER

I hereby request and authorize you to debit my account at the following bank, (or another bank or branch where I may transfer my account) as follows:

Divide the amount which is debited against my school account and instruct my bank to deduct it from my bank account on the first working day of each month.

I agree to pay any fees which my bank may charge with regard to this debit order.

This authorization may be cancelled by me, by giving you written notice thirty days in advance.

Receipt of this authorization by you, is regarded as receipt of it by my bank.

The details of my bank account are as follows:

BANK (e.g. ABSA) / BRANCH NAME
BRANCH CODE / TOWN
ACCOUNT NUMBER
TYPE OF ACCOUNT
(Please indicate
with an X) / CURRENT (CHEQUE) ACCOUNT / SAVINGS ACCOUNT
TRANSMISSION ACCOUNT

Signature as used for signing cheques or for

the withdrawal of funds from savings account

______

Page 6

  • I declare that I am aware that a copy of Hoërskool Middelburg’s constitution is available for perusal during school hours.
  • I undertake to submit myself to the stipulations of the school’s constitution.
  • I declare that all details supplied in this application are correct in all respects and that this document will form the basis for the acceptance of said child as a learner of Hoërskool Middelburg.
  • I declare that I am aware that the language policy of the school is Afrikaans. A limited number of learners will receive education in English.

INDEMNIFICATION

I hereby grant permission that said child can participate in extra-mural activities like sport and cultural events as well as join excursions and tours.

I accept that all reasonable precautions will be taken to ensure his/her safety and I will be personally responsible for the payment of medical and hospital bills (if applicable) in the case of injuries which cannot be ascribed to the negligence of the responsible person.

I transfer my authority as parent to the principal of the school or his representative if medical or surgical intervention might be necessary for my child.

As far as I am aware, he/she is physically able to participate in the above-mentioned activities and is in a good state of health.

However, I request that the responsible persons should pay attention to the following: (E.g. abnormal bleeding, allergies, epileptically fits, etc)

______

The undersigned hereby accepts the conditions of this document.

SIGNED AT ______ON THE ______DAY OF

______(MONTH) ______(YEAR).

______

INITIALS AND SURNAME OF PARENT IN PRINT SIGNATURE

______

NAME AND SURNAME OF LEARNER IN PRINT SIGNATURE OF LEARNER

______

LEARNER’S CELL PHONE NUMBER

DETAILS FOR SMS SYSTEM

Surname & Name of Learner:

Grade & class:

Cell no. of parent for sms purposes:

Page 7

APPLICATION FOR MERIT-DISCOUNT/SCHOLARSHIP ON SCHOOL FEESFOR THE YEAR

______

(This isALSOa survey for extracurricular participation)

NAME AND SURNAME OF CHILD: ______

GRADE: ______CELL.NO. PARENT: ______E-MAIL PARENT: ______

ACTIVITY / PARTICIPATION
(CURRENT SCHOOL)
Mark with an X / TEAM / ACHIEVEMENT
(Honorary colours, MP-team etc.)
Academics
Athletics
Golf
Hockey
Cricket
Cross country
Squash
Netball
Rugby
Chess
Shooting
Swimming
Tennis
Drummies
Other school sports
Dance
Drama
Choir
Art
Land Service
Music
Public speaking
Singing
Other Cultural Activities
Leadership

Page eight

Remarks / Motivation: ______

______

______

______

______

** PLEASE NOTE:

  • Please attach proof of all achievements.
  • Discount on school fees can be awarded for the achievement of provincial colours only in a school sport.
  • The grant of merit discount and scholarships will be in accordance with the merit policy of the school, (see below)the School Government Body will grant approval and their decision will be final.
  • Scholarships which are approved, will be followed up by a contract which must be signed by both parent and learner.
  • Only achievements obtained during the year before admission at MHS, will be considered for approval.

MERIT BURSARIES(Discount on school fees)

  • Head boy/girl – Primary school (> 300 learners)=15%
  • Head boy/girl – MHS=15%
  • Deputy leaders – Primary school (> 300 learners) & MHS =5%
  • Head boy/girl – MHS Hostel=5%
  • Dux learner of the previous year: Grade 7 (school > 300 learners) =15%
  • Top 10 of the previous year – Grade 8-11 (Dux learner excluded)=10%
  • Provincial colours in a school sport (Previous year) A team=10%

B team=5%

  • Cultural achievement on provincial level (Previous year)=10%

PLEASE NOTE: On MERIT – Specify on application form.

Declaration:

Herewith I, ______, parent of ______

declare that above information is correct and true.

Signed______Date: ______

For office use only

Granted:Yes/No / Amount / Acc.no. / Feedback