Once completed the form should be emailed to elitecollege.highschool@gmail.com
ELITE COLLEGE
NPO-052/897
APPLICATION FOR ADMISSION
FORMS TO BE RETURNED TO OUR ADMINISTRATION OFFICE WITH: |
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
NAME | GRADE |
NATIONALITY _____________________________________
MEANS OF TRANSPORT TO SCHOOL
Vehicle | Taxi | Train | Bicycle |
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)
Asthma | Enteric Fever | Measles | Scarlet | ||||
Chicken Pox | Germany Measles | Mumps | Tickbite Fever | ||||
Diabetes | Hepatitis | Poliomyelitis | Typhoid | ||||
Diphtheria | Malaria | Rheumatic Fever | Whooping Cough |
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
Academic | Extra Curricular | Other |
SECTIOND : DETAILS OF ACCOUNT HOLDER FATHER
________________________ ___________________________________
SURNAME FULL NAMES
Mr | Mrs | Ms | Miss | Dr. | Rev | Capt. | Col | Prof. | Rev. | The Hon |
DESIGNATION :
ID NUMBERS:
RELATIONSHIP: ___________________ MARITAL STATUS: _______________
OCCUPATION: _____________________ EMPLOYER: ____________________
ADDRESS1 Residential ADDRESS3postal ____________________________ _______________________________
_____________________________ ________________________________
____________ Post Code ____________ Post Code
( ) _______________________ ( ) _________________________
________________________Cell ______________________ Cell
______________________E-Mail ______________________ E-mail
PARENT STATUS :
Student’s Legal Guardian | Access Right to Studen | Student living with parent | Access Right in an Emergency only |
SECTION E: DETAILS OF KMOTHER/STEPMOTHER/GUARDIAN
________________________ _____________________________
SURNAME FULL NAMES
DEIGNATION:
Mr | Mrs | Ms | Miss | Dr. | Rev | Capt. | Col | Prof. | Rev. | The Hon |
ID NUMBERS:
RELATIONSHIP: _____________________ MARITAL STATUS: _______________
OCCUPATION: ______________________ EMPLOYER: ____________________
ADDRESS1 Residential ADDRESS3 Postal
_____________________________ ____________________________
_____________________________ _____________________________
____________ Post Code _____________ Post Code
( ) _____________________ ( ) _____________________
________________________Cell ______________________ Cell
______________________E-Mail ______________________ E-mail
PARENT STATUS :
Student’s Legal Guardian | Access Right to Studen | Student living with parent | Access Right in an Emergency only |
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.
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
_________________________________________ ________________
Contact Details:
1
School Tel: 011 974 3451
School Fax: 0862248476
School Email: admin@elitecollege.net
Physical address:
1
30 Diesel road, Isando, Kempton Park
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