Once completed the form should be emailed to elitecollege.highschool@gmail.com

ELITE COLLEGE

NPO-052/897

APPLICATION FOR ADMISSION

è 2 Passport photos

è Certified copy of birth certificate or ID Document

è Certified copy of student’s most recent school Report or Statement of Symbol

è If foreign pupil: Copy of pupil’s Residence Permit or Study permit

è Certified copy of recent salary lip of person paying School fees

è Certified copy of same persons ID document

è A R 500 Admission Fee

FOR OFFICE USE:     Admission Number   : ________________

                                     Admission Date          : ________________

                                     Admission Pupil to    : ________________

                                     Receipt Number         : ________________

                                     Amount Paid              : ________________

                                     Year                           : ________________

SECTION A:    STUDENT’S DETAIL

______________________                ________________________________________

SURNAME                                                     FULL NAMES (as per Birth Certificate)

_____________________                  ________________________________________

PREFFERD NAME                                                                ID NUMBER

DATE OF BIRTH ……./……./……./       CURRENT AGE ……./……../       GENDER  M   F

                                  Y    M      D                                       Y      M

HOME LANGUAGE   1._________________                     2______________________

OTHER LANGUAGE SPOKEN ____________________________________________

RELIGION                            _______________________________________________

NUMBER OF CHILDREN IN FAMILY   1   2   3   4 POSITION OF LEARNER IN FAMILY 1  2 3  4

NUMBER OF CHILDREN ATTENDING ELITE COLLEGE   1   2   3   4

NATIONALITY  _____________________________________

MEANS OF TRANSPORT TO SCHOOL      

SECTION B:  MEDICAL INFORMATION

Allergies:_____________________________________________________________

         ____________________________________________________________________

SPECIAL NEEDS: ____________________________________________________________________

                                  ____________________________________________________________________

Family Doctor 1 __________________________ Tel No (        ) ___________________

Family Doctor 2 ___________________________ Tel No (       )___________________

Medical Aid Company                    ________________________________________________________

Medical Aid Membership number    _________________________________________________________

Has the learner received all the necessary Immnisation ? Yes/No (If not pleases give details) ____________

______________________________________________________________________

Learner has suffered the following illnessess: (Indicate with an x)

CONSENT

NB: IN A CRITICAL SITUATION, PLEASE BEAR IN MIND THAT THERE MAY NOT BE TIME

TO REFER TO YOUR CHILD’S RECORDS. THE COLLEGE THEREFORE RESERVES THE

RIGHT TO THE QUICKEST MEDICAL SERVICE AVAILABLE.

1. _______________________________________________, Being the parent/ legal guardian of

________________________________________________ hereby agree that the appointed Elite

College Practitioner may carry out emergency treatment as may be necessary.

Signature of Parent/ Guardian: ______________________________________________

Does the learner suffer from any other illnesses or disability or has the learner suffered from other illnesses

or disability? (If  so, please give details)

______________________________________________________________________

______________________________________________________________________

Has the learner suffered from or been treated for any psychological or emotional upset?

(If so, please provide details)

______________________________________________________________________

______________________________________________________________________

Please  specify any other relevant medical data

SECTION C: PREVIOUS SCHOOL

School 1 ____________________________     School 2 ________________________

Name of the Principal: _________________     Name of the Principal: ______________

Address: ___________________________     Address: _________________________

___________________________________     ________________________________ Code: ____________                                       Code ____________

(…………..) ________________________        (……………) ________________________

Last grade passed: ____________ in which year: _____________ which grade has been repeated __________

Has admission to any other school ever been refused:  Yes          No

Achievements

SECTIOND : DETAILS OF ACCOUNT HOLDER FATHER

________________________                     ___________________________________

SURNAME                                                                              FULL NAMES

DESIGNATION :

ID NUMBERS:

RELATIONSHIP: ___________________         MARITAL STATUS: _______________

OCCUPATION: _____________________        EMPLOYER: ____________________

ADDRESS1 Residential                                     ADDRESS3postal   ____________________________                   _______________________________

_____________________________                 ________________________________

____________ Post Code                                ____________ Post Code

(           ) _______________________              (           )  _________________________

________________________Cell                     ______________________ Cell

______________________E-Mail                     ______________________ E-mail

PARENT STATUS :

SECTION E: DETAILS OF KMOTHER/STEPMOTHER/GUARDIAN

________________________                                _____________________________

SURNAME                                                              FULL NAMES

DEIGNATION: 

ID NUMBERS:

RELATIONSHIP: _____________________     MARITAL STATUS: _______________

OCCUPATION: ______________________      EMPLOYER: ____________________

ADDRESS1 Residential                                     ADDRESS3 Postal

_____________________________                  ____________________________

_____________________________                  _____________________________

____________ Post Code                                 _____________ Post Code

(           ) _____________________                 (           )  _____________________

________________________Cell                  ______________________ Cell

______________________E-Mail                  ______________________ E-mail

PARENT STATUS :

 DECLARATION

We the undersigned , ______________________________________________________________________

Hereby certify that the information given by us on this application is complete and accurate.

We agree to the conditions as set out below.

• We accept that the school is based on Christian principles and undertake not to undermine this position

• We accept joint and several liability to ELITE COLLEGE for the due and punctual payment of all the fees, subscriptions,levies or other amounts which may become due and payable to ELITE COLLEGE or in respect of participation in or attendance of any extra curricular activities.
• We  have read the ELITE COLLEGE  CONSTITUTION, CODE OF CONDUCT and SUBSTANCE ABUSE POLICY and will abide by the rules at the college according to the conditions laid down within.

NB:  The signature of both parents’ and /or guardian AND  Learner are required.

_________________________________________                          ________________

SIGNATURE OF FATHER/STEPFATHER/GUARDIAN                                DATE

_________________________________________                          ________________

SIGNATURE OF MOTHER/STEPMOTHER/GUARDIAN                              DATE

_________________________________________                         ________________