Cell: +27 83 253 8337 lesleysc@telkomsa.net

Enrolment Form

 

 

 

 

Click on the link below to print the form

ENROLMENT FORMS FOR 2018

 

 

ENROLMENT FORM

 

Date Of Admission : (required)

Child's Name : (required)

Child’s Birth Date : (required)

Home Address : (required)

Postal Code : (required)

Postal Address : (required)

Postal Code : (required)

Home Tel Number : (required)

Name/s of Siblings : (required)

Religion : (required)

PARENT DETAILS:

Parent’s Marital Status :

Mother's Name : (required)

Mother's Date of Birth : (required)

Mother's Occupation : (required)

Business Address : (required)

Business Telephone Number : (required)

Cellular Number : (required)

Email Address : (required)

Father's Name : (required)

Father's Date of Birth : (required)

Father's Occupation : (required)

Business Address : (required)

Business Telephone Number : (required)

Cellular Number : (required)

Email Address : (required)

GRANDPARENTS :

MOTHER'S PARENTS :

Names : (required)

Home Address : (required)

Telephone Number : (required)

FATHER'S PARENTS :

Names : (required)

Home Address : (required)

Telephone Number : (required)

NAMES OF ADULTS INTO WHOSE CARE YOUR CHILD IS PERMITTED TO BE RELEASED :

Name : (required)

Relationship to child : (required)

Name : (required)

Relationship to child : (required)

Name : (required)

Relationship to child : (required)

Name : (required)

Relationship to child : (required)

MEDICAL HISTORY

Child's Doctor : (required)

Doctors Tel Number : (required)

Doctor's Address : (required)

Illnesses Since Birth : (required)

Operations Since Birth : (required)

Allergies : (required)

IS THERE A HISTORY OF CHRONIC CONDITIONS IN THE FAMILY:-


IS THERE ANY MEDICATION THE CHILD IS PRESENTLY USING ON AN ON GOING BASIS :


TWO MORE CONTACT PEOPLE IN CASE OF EMERGENCY :-

Name : (required)

Home Address : (required)

Tel Number : (required)

Relationship to Child : (required)

Name : (required)

Home Address : (required)

Tel Number : (required)

Relationship to Child : (required)

BACKGROUND OF CHILD

1) Were There Any Problems Attending The Birth Of Your Child?



2) Was Your Child Breast-Fed And If So For How Long?



3) What Have Your Child’s Sleeping Habits Been Like Since Birth?



4) What Is The Child’s Relationship To Other Siblings?



5) What Does Your Child’s Diet Consists of In General?



6) What Are Your Child’s Favourite Activities And Interests At Present?



7) Is Your Child Potty-Trained? And If So At What Age Did This Happen?



 

 

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