LEARNER INFORMATION. Surname: Official Name(s): Preferred Name: Date of birth Sex Commencement date: Religion Learner lives with – Mother Father Both Allergies Dietary requirements: Any special needs/learning difficulties/disabilities: Xxxxx score at birth: Medical Aid name: Medical Aid number: Main Member: Scheme: Name of Family Doctor: Contact No: I HAVE SELECTED THE FOLLOWING OPTION FOR 2020 TIMES: 12:15pm 12:45pm 2pm 3pm (excludes lunch) (includes lunch) DAYS ATTENDING PER WEEK: 3 days (1-2 class only) 5 days Payment Plan Monthly Termly Annually FATHER’S FULL NAME:
LEARNER INFORMATION. Age group for Pre-R (4 turning 5) Age group for Grade R (5 turning 6) Grade applied for: Highest Grade Passed Year When Grade was passed: Name & Surname: Gender: Date Of Birth: Race: Citizenship: Residential address: Home Language: 2nd Language: Religion: Left-Handed Right-handed Identification Number: Learner is, Mode of Transport: Deceased Parent(s) None Mother Father Both SIBLINGS Number of other children at this school: Name & Surname: Grade: Name & Surname: Grade: Name & Surname: Grade: PREVIOUS SCHOOL INFORMATION Name of the previous School Previous School Address Province & Country LEARNER MEDICAL INFORMATION Medical Aid Number Medical Aid Name Medical Aid Main Member Doctor Name Contact Number Allergies Learner’s Medical Condition* Special problems requiring Counselling: PARENT / GUARDIAN INFORMATION Title: Initials: Gender: Race: Full name & surname: Xxxxxxx Status: Relationship with the learner: ID Number: Primary Contact number: Residential Address: Occupation: Alternative contact number: Emergency family member (name & Surname): Relationship with the child: Contact number: OTHER RELATIVE DETAILS Name & Surname: Relationship with the child: Contact number: Residential Address: INDEMNITY FORM NO YES Application Accepted: Rejected by: If No, reason: Date: I, the undersigned, Full name & surname the of do hereby request the staff of Shekinah Christian School to act in my place in all respect in my absence. I do hereby indemnify the staff and the school against any claim arising out of any harm or damage which may be caused to the learner such period – however caused. Signature
LEARNER INFORMATION. Name: Address: Postcode: Contact Telephone: Date of Birth: Parent / Carer Names(s) Address: Contact Telephone:
LEARNER INFORMATION. (as reflected on identity document or birth certificate) Surname: First Name/s in full: Preferred name: Date of Birth: Identity number: Country of birth: If not born in SA, date of entry to SA: Passport number: Study Permit / SA Qualifications Authority permit number: Religious denomination: Home language: Learner’s cell phone number (if available): Race: Name, address, telephone and fax number of present school: Present grade: Language of instruction at present school: First additional language at present school: Grade applied for: Cultural activities participated in at present school: Sports activities participated in at present school: Leadership positions at present school:
LEARNER INFORMATION. Xxxxxxx’s Name and Surname: Proposed Grade of Entry: Proposed Year of Entry: Date of Birth: Present Age: Gender: BOY GIRL Home Language: Religion: Previous School: Tel No. Previous School: Medical Aid: Medical Aid No: Doctor’s Name: Doctor’s Tel No: Number of Children in Family: Position of Learner in Family: I/We have the following learners at: (*Provide Name and Surname and School) Arbor Pre-Primary Arbor Primary Other (specify) 1.
LEARNER INFORMATION. Surname: Official Name(s): Preferred Name: Date of birth Sex Commencement date: Religion Learner lives with – Mother Father Both Allergies Dietary requirements: Any special needs/learning difficulties/disabilities: Xxxxx score at birth: Medical Aid name: Medical Aid number: Main Member: Scheme: Name of Family Doctor: Contact No: I HAVE SELECTED THE FOLLOWING OPTION FOR 2021 TIMES: 12:00pm (Under 3 only) 12:45pm 2pm 3pm DAYS ATTENDING PER WEEK: 3 days (under 3 only) 5 days Payment Plan Monthly Termly Annually ( X 12 including holiday months & December) FATHER’S FULL NAME:
LEARNER INFORMATION. All learners are made aware of their right to appeal the results of any assessment as part of the course induction and also in the Learner Handbook.
LEARNER INFORMATION. All learners are made aware of the Complaints Procedure as part of their course induction, and they are also advised of this in the Learner Handbook. The aim is to make it as easy as possible for learners to raise any concerns or dissatisfaction with Qualtec’s services, training delivery or learner supports so that matters can be dealt with promptly and courteously.
