KILDARE PRE-PRIMARY SCHOOL

75 Kildare Road, Newlands, 7700 Tel: +27 (0)21 6744360 Fax: +27 (0)21 6741035 Email: kildare@megaweb.co.za www.kildarepreprimary.co.za

APPLICATION FOR ADMISSION

Name of Learner:
(First and Surname)

Date of Birth: DD/MM/YY Year and Term Applying for: Year of Entry to Grade One:
(in the year they turn 7 yrs old)

Year Gender:

Term Boy Girl

Proposed Primary School

Application Information and Requirements Please complete ALL sections. Please supply a physical address as well as a postal address if applicable. No faxed applications will be accepted. The application must be accompanied by the following documents: o Copy of learners Birth Certificate / Passport o Proof of residence o Medical Details where relevant

Please attach a photo of your child in this box

REGISTRATION FEE: A R100 non-refundable registration fee is payable when submitting your application. Please note that applications will not be processed unless this fee and all the relevant documentation have been received. Completion of this application form does not guarantee that your child will be accepted at Kildare Pre Primary School. Once your child is ACCEPTED one full terms notice is required before the child is removed. You will be liable for the fees for that term. th **Children must turn 4 years old by 30 June in the year of entry to be eligible to attend Kildare. BURSARY A limited number of bursaries are available. Bursary application forms (available from the office) must be submitted during September of the year prior to when the bursary is required.

** Subject to change Closing date for applications: End of first term, one year before the year of entry NO INCOMPLETE FORMS WILL BE ACCEPTED

FOR OFFICE USE ONLY:

RECEIVED ON: DOCUMENTS RECEIVED Learners Birth Certificate Proof Of Residence Data captured Excel ACCEPTED Acceptance form rec.: Deposit received: Class Data Captured Pastel Yes No

LEARNER DETAILS (as appears on Birth Certificate use block letters) Surname First Names Called Name, if different to first name above OTHER PERSONAL DETAILS OF LEARNER Nationality Place of Birth Home Language ID Number Religion Name of current Playschool PARENT/GUARDIAN DETAILS FATHER: Surname First Names ID Number: Occupation: Name of Employer: Home Telephone no. Work Telephone no. Cell Phone no. Email address: Marital Status: MOTHER: SA Citizenship Date of Arrival in SA Country of origin Place in family of YES NO

Residential address Code: Code:

Postal Address: Code: WHO DOES THE LEARNER RESIDE WITH? Both Parents Mother Father Guardian Grandparents Other Code:

CORRESPONDENCE Please indicate who is to receive the school report Please indicate who is to receive the school account Please indicate which parent could receive email communication Father Father Father Mother Mother Mother Guardian Guardian Guardian

KILDARE INFORMATION (Fill in where applicable)

Name of siblings who attended Kildare. Was mother or father a past pupil of Kildare?

Year

Year

MEDICAL INFORMATION Please indicate Birth Weight Family Medical History (allergies, congenital abnormalities, etc) Any problems during pregnancy / confinement Any Post-natal problems with child (jaundice/lights, etc) Teething: Milestones Give age when child started Talking: Illnesses your child has had: Other important illnesses current or in the past Illnesses against which immunized Operations your child has had. Any serious accident Hearing: Any problems connected with Teeth: Urination: Is the child on special medication? Any allergies? Any food or drink the child must avoid? Name of Family Doctor Address and Tel No. Name: Add: Tel. No. Sight: Speech: Measles Asthma Tuberculosis Tetanus German Measles Epilepsy Whooping Cough German Measles (m.m.r) Polio Mumps (m.m.r) Measles(m.m.r) Diptheria Toilet Trained: Whooping Cough Mumps Chicken Pox Crawling: Walking:

Remarks