FOR OFFICE ONLY. Occupation: Company/Organisation: Work Phone Number: Home Phone Number: Fax Number:. ADDRESS:...

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1 P.O. Box 1242, Gweru Zimbabwe Telephone: , , , Fax: APPLICATION FORM SIXTH FORM (L6 & U6) Rec. No.:.. App. Returned: FOR OFFICE ONLY Date:. Signature:. FIRST NAME & SURNAME OF PUPIL (Please Print):. Date of Birth: Present Form/Grade:. Proposed Date of Entry:... Country of Permanent Residence:. Sex: Religion: Race (for Min. of Ed):.Boarder or Day Pupil (see note 2 below):. Details of Parents: Father Mother Name: Occupation: Company/Organisation: Work Phone Number: Home Phone Number: ATTACH PASSPORT SIZE PHOTOGRAPH OF APPLICANT HERE Fax Number:. ADDRESS:.... Home Address: Housing Status : Owned Rented Owned Rented Postal Address: Cell: If the legal guardian is not father or mother, please give name and address:.. Are there any family problems, e.g. divorce or separation of parents? * A Level Subjects prefered: Sciences Arts Commercials Name of Previous School & Postal Address Dates Attended Level Reached Names of other Children in the family Ages Present School How did you hear about the school?:.. Signature of Parent / Guardian: NOTES: 1) To gain entrance pupils must pass the Entrance Examination 2) Gweru residents will not be allowed to send their children as Boarders unless exceptional circumstances exist. These must be explained 3) An Administration Fee of USD. (non-refundable) paid on collection or submission of this form. 4) Certified copy of pupils Birth Certificate and MOST recent copy of school report to be submitted. 5) Please notify the Enrolment Secretary of any change of address or phone number. P.T.O Isaiah 40 vs 31 Those who trust in the Lord for help will find their strength renewed. They will rise on wings like eagles; They will run and not get weary; They will walk and not get weak.

2 Entrance Agreement 1. I certify that the information given on this application is complete and accurate. 2. I understand that my child will not be admitted unless all prescribed fees have been paid. 3. I declare that I have the financial ability to pay the fees. 4. I note that my child, if admitted, will be required to comply with the rules and standards, both in school and out of school, and to render prompt obedience to the school staff as long as he/she is enrolled as a pupil. 5. I accept corporal punishment for my child, administered according to the Ministry of Education s policy and procedures. 6. I am willing to abide by the decision of the Principal as to the form and set in which the child will be placed. 7. If I intend to withdraw the child, I agree to give one full calendar month s notice before the end of the child s final term at the school. 8. I acknowledge that my child s admission is subject to, among other things, his/her passing the entrance examination and selection test that may from time to time be in force, and subject to my final acceptance of an offer of place, when such an offer is made. I also accept that the actual test results are confidential and the College has no obligation to disclose the actual test mark(s). Signature of Legal Custodian of child.date Capacity of Signatory (i.e Parent/Guardian)..

3 BOARDING HOSTEL APPLICATION FORM Name of Pupil: (First Name). (Surname). Sex: MALE / FEMALE Date of Birth:... Current Grade / Form: Current School:. Proposed Hostel Enrolment Date: Name of Parent / Guardian:.. Address: Telephone Nos: (Home).. (Business).. Name of Parent / Guardian / Company responsible for fees: Signed: Date: PLEASE NOTE: 1. PAYMENT MUST BE MADE PRIOR TO ENTRY INTO THE HOSTEL. 2. NAMES WILL NOT BE ENTERED ON THE WAITING LIST UNLESS THIS FORM HAS BEEN SUBMITTED TO THE SCHOOL OFFICE. *** PLEASE SIGN THE DECLARATION OVERLEAF ***

4 CRITERIA FOR ENTRY: 1. Pupils who are presently in our Junior Hostel have preferential consideration for entry to our Senior Hostel subject to them passing the College entrance examination, recommendation by the Headmaster/Headmistress of MCS with the agreement of the Hostel Superintendent and payment of Hostel fees has been made. (Please note that transfer from Junior to Senior Hostels requires a further hostel fee and application form). 2. Pupils who are already in Hostel may remain if their home location changes with the exception of relocation to the Gweru urban area, in this case it is expected that the student will become a day scholar at the end of that term during which the relocation has taken place. 3. Pupils will only be offered hostel places if they have been admitted into the School or College. DECLARATION BY PERSON WHO HAS LEGAL CUSTODY OF THE CHILD I, (full name) of (main residential address).. DECLARE THAT: 1. The information given in this application for enrolment is true and correct. 2. I understand that my child may not be admitted unless all prescribed fees have been paid. 3. I undertake to inform the School / College should circumstances change such that the criteria for entry as set out above are not satisfied. 4. I note that my child, if admitted, will be required to conform to the standard of discipline enforced at the hostel, that he/she will render prompt obedience to the Hostel Superintendent, Matrons and staff, and be courteous and well-mannered at all times; students are expected to be an asset to our Hostels. 5. I understand that acceptance into the hostel is also dependent on the general terms and conditions of the School and/or College being fulfilled. Signature: (Parent / Legal Guardian) Date:..

5 P.O. Box 1242, Gweru Zimbabwe Telephone: , Fax: , PHYSICAL EXAMINATION Relative to Application for Admission to MCC (To be completed and mailed by examining physician to the school or alternatively put in a sealed envelope for the parent/guardian to forward to us) Surname: First Name:. Middle Name:.. Address:. Date of birth: Sex : M / F Height: Weight:.. Blood Pressure:. Pulse:. Vision without glasses:. Vision with glasses:. Check each item in proper column 1. Mouth, Teeth 2. Throat, Tonsils 3. Nose, Sinuses 4. Hearing 5. Lungs, Chest 6. Heart (estimate Cardiac function) 7. Abdomen 8. Endocrine System 9. Genitor, Urinary System 10. Skin 11. Neurological System Normal Abnormal Give details of abnormalities Please answer the following questions. Please explain all yes answers. If additional space is needed please use reverse side, 1. Is there any present illness? Yes No Is there a history of any previous serious illness? Yes No Is this individual allergic to any drug? Yes No... Isaiah 40 vs 31 Those who trust in the Lord for help will find their strength renewed. They will rise on wings like eagles; They will run and not get weary; They will walk and not get weak.

6 4. Are there any other allergies? Yes No Does this individual show any signs of emotional instability? Yes No Is this individual on any drugs at present? Yes No Is there any reason that this individual should not take physical education or sports? Yes No Is there any reason that this individual should not take swimming? Yes No... Comments :... Vaccinations Required for admission (Please give Day, Month and Year for each) PPD Neg Pos Date: /.. / (If positive, a chest x-ray is required to be done) Tetanus date of last vaccination :.. /.. /.. MMR (Measles, Mumps & Rubella) : 2 dates required :.. /.. /.. and.. /.. /.. Doctor s Name :.. Date of Examination : Doctor s Signature :. Please mail to : The Principal Midlands Christian College P O Box 1242 GWERU, Zimbabwe Physical Address: Long Road, Christmas Gift, Gweru, Zimbabwe Or alternatively you may put this document in a sealed envelope and give it to the parent to forward to us (Envelope must be marked CONFIDENTIAL)

7 P.O. Box 1242, Gweru Zimbabwe Telephone: , Fax: , TRANSCRIPT REQUEST FORM Please complete Section A of this form and take or send it to your child s school he or she has attended for completion of Section B. SECTION A Pupil s Surname :.. First Name :. Address :... Date of Birth : Name of School: Date attended this school : From to Name of Parent or Guardian : Signature of Parent or Guardian : Date :.. SECTION B: TO BE COMPLETED BY THE SCHOOL 1. PUPIL S APPROXIMATE POSITION IN CLASS (Please tick) Top Quarter..Second Quarter..Third Quarter..Bottom Quarter. Is the pupil s class: top..middle..bottom one of the year, or unstreamed? 2. Please mark as accurately as you can your estimate of the pupil s performance in the following categories using the formula below. Outstanding Very Good Above Average Average Below Average Weak Please the appropriate box. Subject Outstanding Very Good Above Average English Maths Science Other subjects Average Below Average Weak Isaiah 40 vs 31 Those who trust in the Lord for help will find their strength renewed. They will rise on wings like eagles; They will run and not get weary; They will walk and not get weak.

8 3. Academic Prizes and Awards Indicate Class, Year and Honour : Class Year Honour 4. CHARACTER ASSESSMENT Please tick rating Time Management (Punctuality & meeting deadlines) Excellent 5 Very Good 4 Good 3 Fair 2 Poor 1 Very Poor 0 Inter-personal Relations (with peers, with authority) Independent Study (Homework & Reading) Hygiene and Smartness Conscientiousness Respect of Rules & Authority Integrity & Honesty Leadership Potential 5. EXTRA MURAL PARTICIPATION Cultural Interests Awards Indicate Date, Discipline and Honour/Achievement Date Discipline Honour/Achievement 6. Does the pupil have any significant physical or learning impairment? Yes / No (If Yes, please elaborate).

9 7. PARENTAL SUPPORT Please comment on parental support : Parent/Teacher Consultation Meetings Regular Attendance Sometimes Attends Never Attends Parents Association Meetings Payment of Fees Always on Time Sometimes Delays Always Late 8. RECOMMENDATION Is this pupil (please tick) : Recommended for admission Recommended with reservation for admission Not recommended for admission 9. GENERAL COMMENT Please make any relevant comments : Head s Name : Head s Signature :.. Telephone No : Date :. Please post this form directly to : The Principal Midlands Christian College P O Box 1242 GWERU ZIMBABWE Physical Address: Long Road, Christmas Gift, Gweru, Zimbabwe Or alternatively you may put this document in a sealed envelope and give it to the parent to forward to us The envelope should be marked CONFIDENTIAL PUPIL INFORMATION