Enrolment Form

All fields are required when submitting the enrolment form. Make sure you have a copy of your child's Birth Certificate and Immunisation Card to attach.

Child's Details

Child's Name:

Sex:
MaleFemale

Date of Birth:

Home Language:

Parents/Guardian Details

Mother's Name:

Father's Name:

Mom's Work Phone:

Dad's Work Phone:

Mom's Cell:

Dad's Cell:

Home Phone:

Email:

Residential Address:

Medical Details

Medical Aid Name:

Medical Aid Number:

Main members name and initials::

Preferred hospital:

Name of G.P:

G.P. Phone Number:

Any Known Allergies:

Upload Medical Documents

Attach Child's Birth Certificate:

Attach Child's Immunisation Card:

Maximum file size 10MB ( jpg, jpeg, png, gif, pdf, doc, docx)

Signature of Parent/Guardian:

Use your mouse or finger (mobile) to sign the form below:

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