Preschool Enrolment Form
1
Child Information
Child's Name
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Child's Surname
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Child's date of birth
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Select a date
Gender
Select Gender
Male
Female
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Home Address
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Child Postal Address
Child Nationality
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Home Language
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Child Religion
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Child Allergies and medical information
Name Of Medical Aid
Name Of Doctor
Doctor Telephone Number
step 2
2
Father Information
Father's Name
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Father's Surname
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Fathers ID or Passport Number
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Father's CellPhone Number
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Father's Work Number
Father's Occupation
Fathers Email
Father's Marital Status
Select an option
Married
Single
Divorced
Widowed
Please select a valid marital status.
step 3
3
Mother Information
Mother's Name
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Mother's Surname
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Mother's ID or Password Number
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Mother's Cell Phone Number
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Mother's Work Number
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Mother's Occupation
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Mother's Email
Mother's Marital Status
Select an option
Married
Single
Divorced
Widowed
Please select a valid marital status.
step 4
4
Resposible
Person Resposible For Payments of Fees
Name
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Surname
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CellNumber
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Email
ID Number
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step 5
5
Emergency Contact
Person who can be contacted in case of an emergency when parents cannot be reached.
Emergency Name
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Emergency Surname
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Emergency Cell Number
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Relationship to child
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Can we Administer Medication to your Child in case of fever
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Until what time will your child be staying
12h30
14h00
17h15
step 6
6
Additional Information
1. Are there any concerns of:
Hearing Loss or difficulties
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Vision difficulties
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Speach Difficulties
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Physical Disabilities
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2. Is your child potty trained and does he/she know hoe to use the toilet?
Select an option
Yes
No
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3. Does your child have any social or special educational needs
4. Does your child have any medical conditions? if yes please detail below.
5. Has your child attended a pre-school before? if yes, please provide the name and telephone number
Pre School Name
Pre School Number
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