DEPARTMENT OF EDUCATION ADMISSION APPLICATION FORM

Transcription

1 DEPARTMENT OF EDUCATION ADMISSION APPLICATION FORM 1. SCHOOL DETAILS 1.1 Gauteng registration (EMIS) number District : D9 1.3 Name of school: Rosebank Primary School 1.4 Type of school: Sectional School entry grade Grd R 1.6 School exit grade (Last grade offered at school) Grd 7 2. DETAILS OF LEARNER ( All information must correspond with details on official documents) 2.1 Date of application (Submission) 2.2 Surname 2.3 First name. 2.4 Identity number. 2.5 Passport number/ Other reference number (Must be from a official document) 2.6 Grade applying for: 2.7 Certified birth and immunization certificate attached 3. DETAILS OF PARENTS/GUARDIANS YES NO 3.1 Postal Home adress : 3.2 Postal Work Adress 3.3 Name: Surname: Contact number: 3.4 Identity number: 3.5 Specify PARENT GUARDINAN 4. GENERAL DETAILS 4.1 Based on the school at which the application is made, indicate the following: Does the parent Live in the area Work in the area Has a child / Sibling in the school YES NO 4.2 For applicants in Grades 2 to Previous school attended Public Ordinary Independent

2 4.2.2 Reasons for leaving previous school: Unaffordability Expulsion Behavioural problems Failing grade once or more School provided a transfer card without explanation Disciplinary action problems Repeating a grade Relocation within Gauteng Relocation from another province Relocation from another country Province relocating from Country relocating from 5. WAITING LIST NUMBER 5.1 List A A 5.2 List B B 6. NEXT OF KIN/RELATIVE(S) OTHER THAN PARENT OR GUARDIAN (Parent signature conformation of Waiting List number) Surname First Names Relationship with learner Address Telephone number Family doctors name Doctors telephone nr Parent / Guardian Name: Parent / Guardian Cell number: Principal Name Contact number Mr L Lambert Parent / Guardian Signature: Date Principal Signature Date

3 TEL: FAX: Rosebank School 13 Jellicoe Ave Rosebank Johannesburg 2196 Founded ENROLMENT INFORMATION Thank you for the interest that you have shown in applying for a place at Rosebank Primary School. Please note that applicants enrolling for Grd R must turn 5 years of age by the 30 th June 2012 and Grd 1 applicants must turn 6 years of age before the 30 th June The Language of Teaching and Learning at Rosebank Primary School is ENGLISH therefore it is imperative that your child is able to read, write and speak English. Please be aware that the First Additional Language (FAL) from Grd 1 to 3 is Afrikaans and Grd 4 to 7 have a choice between Afrikaans and Zulu. This must be indicated on the application form and cannot be changed once a decision has been made. Documentation The following documentation must be submitted with the completed application form: 1) Certified copy of the Birth Certificate. 2) Certified copy of official immunization card or proof confirming immunization against polio, measles, tuberculosis, diphtheria, tetanus and hepatitis B. 3) Latest school report. 4) Certified copy of parents or guardians Identity Documents. 5) Proof of residential address (in the parent s name) such as statements of Rates, Water and Lights, Telephone or store account, etc. 6) Proof of income. 7) Transfer Card of previous school and final report. Parents / Guardians of other nationalities must submit the following additional documents: 1) Study permit in respect to learner. 2) Temporary or Permanent Residence Permit from the South African Department of Home Affairs or evidence of application. To ensure that your application has every chance of consideration, it is vital that you read through this form carefully, provide all the necessary information and documentation and return the application form as quickly as possible. If the required information is incorrect, incomplete or documentation is missing, it will delay the processing and evaluation of the application. Acceptance Requirements: On acceptance of your child at Rosebank Primary School, you will be required to: a) Pay a Learner Affiliation Fee (LAF) that includes: Grd R Exercise books, chairbag, book bag, tog bag, house t-shirt, photographs, presentations, ear & eye tests, plastic book covers, 2 reams of photocopy paper, perceptual books and an admin fee. Grd 1 to 7 Exercise books, plastic book covers, perceptual books, photographs, presentations, ear & eye tests and 2 reams of photocopy paper. b) 2014 School Fees are estimated to be R for the year (confirmation at the AGM in September 2013). The current school fees are R c) Rosebank Primary School is a state-sided school and the payment of school fees is compulsory. Should you require any further information, please do not hesitate to contact the office between 07h30 and 14h00 (Monday to Friday). Please note that only original applications will be accepted therefore no faxed or ed applications will be considered. Applications close on 21 st May 2013.

4 SECTION B 1. Learner s Information Gender: BOY or GIRL? Name of previous school: Address of previous school: Telephone of previous school: Fax of previous school: ROSEBANK PRIMARY SCHOOL APPLICATION FORM 2014 Date of Birth: Home Language: First Additional Language Choice (GRD 4 to & ONLY) Select one below: Afrikaans Zulu Sibling Information Name/s of brothers or sister at Rosebank Primary School: Name: Name: Sports House: Grade: Grade: Additional Information With whom does your child reside (both parents, mother, father, grandparent, guardian, etc)? Any information that you feel the school should be made aware of? For Office Use Only: Family Number: Admission No: House: LAF: Birth Certificate: Immunisation: Identification Docs: Report: Proof of Income: General Comments Additional Father / Guardian s Details Home Tel number: Work Tel number: Employer: Address: Marital Status: Cell Number: Fax Number: Occupation:

5 Please provide details of the other parent. Surname: Title: Home Tel number: Home Address: First Name: ID Number: Marital Status: Cell Number: Postal Address: Employer: Work Address: Occupation: Work Tel number: Address: Emergency Contact Information (other than a parent) Name of Medical Aid: Allergies and or / medical problems: Fax Number: Medical Aid number: In the event of hospitalization, please indicate your preference below: Private Hospital: Provincial Hospital: Payment of School Fees: Rosebank Primary School is a Sectional 21 school which is a fee paying school. Consequently, parents / guardians are legally bound to pay school fees. Should a family renege on its responsibility to pay school fees, they can be blacklisted or have legal action taken against them by Rosebank Primary School. I understand and accept the school fee responsibilities: (YOUR NAME) (SIGNATURE) (DATE) Please note that if you are placed onto Waiting List B, there is no guarantee of acceptance of your application. Principal s name: Mr L Lambert Contact Tel number: Signature: Date: