ENROLL HERE Complete the Online form OR DONWLOAD FORM SurnameFirst NamesPreferred NameGenderMaleFemaleOtherID / Passport NumberDate of BirthDate of entry to centerName of present schoolCitizenshipCountry of OriginHome language2nd LanguageSpecial dietary requirements:Position in the familyWho will collect the child from school?Preferred NameSurnameGenderMaleFemaleOtherFirst NamesDate of BirthID / Passport NumberDate of entry to centerName of present schoolCountry of OriginCitizenshipHome language2nd LanguageSpecial dietary requirements:Position in the familyWho will collect the child from school?SurnameFirst NamesPreferred NameGenderMaleFemaleOtherID / Passport NumberDate of BirthName of present schoolDate of entry to centerDate of entry to centerName of present schoolCountry of OriginCitizenshipHome language2nd LanguageSpecial dietary requirements:Position in the familyWho will collect the child from school?TitleID / Passport NumberMarital StatusMarriedSingleLive TogetherDivorcedWidowedRelationSurnameNameStreet AddressApartment, suite, etcCityState/ProvinceTell NumberTell NumberCellphone NumberOccupationEmployerTitleID / Passport NumberRelationSurnameNameStreet AddressApartment, suite, etcCityState/ProvinceTell NumberTell NumberCellphone NumberEmail AddressTitleID / Passport NumberRelationSurnameNameStreet AddressApartment, suite, etcCityState/ProvinceTell NumberCellphoneTell NumberOccupationEmployerEmail AddressIf separated or shared custodyAllergies, illnesses or other information on state of healthListDoctor’s nameDoctor’s phone numberMedical Aid nameMedical Aid numberPrincipal MemberAre your Child’s immunizations up to date?YesNoUpload ID/PassportChoose FileNo file chosenDelete uploaded fileChild Clinic Card / Proof of Medical AidChoose FileNo file chosenDelete uploaded fileProof of AddressChoose FileNo file chosenDelete uploaded fileSUBMIT
