Registration/Admittance Form - Window 2 Learning

Registration/ Admittance Form

To ensure the smooth running of Window 2 Learning Excellence and to rule out any uncertainty, PLEASE:

Read
Complete
Attach certified copies of the following documents along with the Registration/Admittance form
Father / Stepfather/ Legal Guardian ID Document
Mom / Stepmother / Legal Guardian ID Document
Emergency Contact ID
Birth Certificate of Learner
Most recent School Report of Learner
Medical Aid Card
2 Coloured ID Photos of learner
Copy of Vaccination Record of Learner

The Learner

First Name

Middle Name

Last Name

Date of Birth

ID Number

Gender

Male Female

Home Language

Other Language

Number of Children in Family

Position of child in family

Religion

PHYSICAL ADDRESS

Street Address

City

State / Province / Region

Postal / Zip Code

POSTAL ADDRESS

Street Address

City

State / Province / Region

Postal / Zip Code

Phone

Parents/Guardians Information

DETAILS OF FATHER/STEPFATHER/GUARDIAN

Title

First Name

Middle Name

Last Name

ID Number

Cellphone Number

Work Number

Relationship to child

Employer

ADDRESS

Street Address

City

State / Province / Region

Postal / Zip Code

DETAILS OF MOTHER/STEPMOTHER/GUARDIAN

Title

First Name

Middle Name

Last Name

ID Number

Cellphone Number

Work Number

Relationship to child

Employer

ADDRESS

Street Address

City

State / Province / Region

Postal / Zip Code

DECLARATION OF PARENTS / LEGAL GUARDIANS

We, the undersigned, hereby certify that the information given by us in this Registration/Admittance form is complete and accurate. We also agree on the conditions as set out herein. This application form will be reconsidered in the case where important relevant information, which should be brought to the attention of Window 2Learning management, is withheld.

Title

First Name

Middle Name

Last Name

EMERGENCY CONTACT INFORMATION
(other than Mother or Father or Guardian)

Title

First Name

Middle Name

Last Name

Id Number

Relationship to child

Cellphone Number

Work Number

Account Holder Information

Title

First Name

Middle Name

Last Name

Id Number

Relationship to child

Cellphone Number

Work Number

PHYSICAL ADDRESS

Street Address

City

State / Province / Region

Postal / Zip Code

POSTAL ADDRESS

Street Address

City

State / Province / Region

Postal / Zip Code

DECLARATION OF ACCOUNT HOLDER

I, the undersigned, hereby certify that the information given of the Account Holder in this Registration/Admittance form is complete and accurate. I accept joint and several liability to Window 2 Learning for the due and punctual payment of fees and any other amount which may become due.

Title

First Name

Middle Name

Last Name

Learner’s Educational Details/h5>

Current/Previous School

ADDRESS OF SCHOOL

Street Address

City

State / Province / Region

Postal / Zip Code

Tel No

Principal

Has admission to any other School/s ever been refused?

Yes No

If Yes, please state reason.

Learners Medical Details

Medical Aid Name

Medical Aid Number

Main Member ID Number

Dependant Code of Learner

Option/Plan

Has the learner received all the necessary immunisations?

Yes No

If No, please state reason.

Does the learner have any Allergies or Special medical needs

Any Additional Comments

Uploads

Attach certified copies of the following documents

Birth Certificate of Learner

Father / Stepfather/ Legal Guardian ID Document

Mom / Stepmother / Legal Guardian ID Document

Emergency Contact ID

Medical Aid Card

Most recent School Report of Learner

Coloured ID Photos of learner

Copy of Vaccination Record of Learner

Address

Contacts

Working Hours