LOMPEC PRE SCHOOL ( LOMPEC EDUCATION CENTRE ) ( ASSOCIATION INCORPORATED UNDER SECTION 21 ) Ledwaba Street P. O. Box 77139

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1 Reg No.2008/010115/08 LOMPEC PRE SCHOOL ( LOMPEC EDUCATION CENTRE ) ( ASSOCIATION INCORPORATED UNDER SECTION 21 ) Ledwaba Street P. O. Box P.O. Rethabile Mamelodi Mamelodi East TEL : (012) EMIS No.: lompec@icon.co.za FAX : (012) NPO No.: website: =========================================================================== REGISTRATION 2016 Your application to study at the above school will be considered upon submission and verification of the following documents. You are now required to submit the following: 1. Application Form 2. Registration Fee 3. Medical Report and Clinic Card (Immunization Card) 4. Birth Certificate 5. Both Parents Certified ID / Passport 6. Proof of Residence 7. For Grade R all learners should be 5 years or turning 6 after June 2016 Our first term commences on the (06 th January 2016 at 07:30) Yours Faithfully... L. Makola Registrar

2 APPLICATION FORMS PRE - SCHOOL 2016 INFORMATION OF THE CHILD SURNAME : FIRST NAMES : DATE OF BIRTH : CHILD INFORMATION GENDER : MALE [ ] FEMALE [ ] AGE [ ] HOME LANGUAGE : ALLERGIES : GENERAL : DECEASED: MOTHER [...] FATHER [...] BOTH [...] SOCIAL GRANT: YES [...] NO [...] RESIDENTIAL ADDRESS RESIDENTIAL ADDRESS: AREA CODE : CONTACT NUMBER : CONTACT PERSON / EMERGENCY NUMBER : PREVIOUS PRE-SCHOOL INFORMATION NAME OF PRE-SCHOOL ATTENDED: PROVINCE: REFERENCE: YEAR: TELEPHONE No: I hereby acknowledge that the above information is to the best of my knowledge and believe true and correct. I also believe that no monies will be refunded for any reason whatsoever and that all fees shall be paid before the 4 th of every month. NB. : This application form will not be valid without payment of registration fee Signature Of Parent Date Page 1

3 SURNAME : FIRST NAMES : ID/ PASSPORT NUMBER : PARENTS INFORMATION MOTHER S INFORMATION MARRIED [ ] SINGLE [ ] DIVORCED [ ] WIDOW [ ] RELATIONSHIP WITH CHILD: PARENT [ ] GUARDIAN [ ] FORSTER CARE [ ] ADOPTED [ ] POSTAL ADDRESS : CONTACT INFORMATION POSTAL CODE : WORK TEL NO. [ ] HOME TEL NO. [ ] CELLPHONE NO. : MEDICAL AID : MEDICAL AID NUMBER : FAMILY DOCTOR : DOCTORS CONTACT NUMBER : NAME OF COMPANY : POSITION/DESIGNATION : MEDICAL INFORMATION WORK INFORMATION CONTACT NUMBER : [...] CONTACT PERSON : WORK ADDRESS: NUMBER OF YEARS IN COMPANY : SURNAME : FIRST NAMES : ID NUMBER : AREA CODE: FATHER S INFORMATION MARRIED [ ] SINGLE [ ] DIVORCED [ ] WIDOW [ ] RELATIONSHIP WITH CHILD : PARENT [ ] GUARDIAN [ ] FORSTER CARE [ ] ADOPTED [ ] Page 2

4 MEDICAL INFORMATION MEDICAL AID : MEDICAL AID NUMBER : FAMILY DOCTOR : DOCTOR S CONTACT NUMBER : WORK INFORMATION NAME OF COMPANY : POSITION/DESIGNATION : CONTACT NUMBER :[ ] CONTACT PERSON : WORK ADDRESS: AREA CODE: NUMBER OF YEARS IN COMPANY : CONTACT INFORMATION POSTAL ADDRESS: POSTAL CODE : WORK TEL NO.: [ ] HOME TEL NO.: [ ] CELLPHONE NO.: Note: 1. All children must wear the prescribed school uniform. 2. Monthly fees should be paid on or before the 4 th of every month. 3. All children must report at 7:00am daily (see overleaf for after care school details) 4. Sick pupils must not attend classes. 5. Unfortunately we are unable to admit disabled or mentally challenged children. 6. Swipe your debit/credit card at our offices or pay your monthly fees at the college or deposit it in the college s bank account Page 3

5 PRE SCHOOL FEES Grade R Registration Fee : R Monthly Fees : R x 11 months (February to December) Total Fees : R pa NB: CASH PAYMENTS: 10% discount to be refunded to parents and not to companies if fees are fully paid by the 31 st January SUBJECTS : LITERACY LIFE SKILLS NUMERACY AFTER SCHOOL CARE Time : 4pm - 6pm Grades : All Grades Fees : R per month NB: Children NOT registered for after school care will be charged as follows: An amount of R50.00 will be charged for any learner who will be collected after 16:15. Page 4

6 UNIFORM Boys : Navy Blue short pants White Golf T-Shirt / School T-Shirt Maroon Jersey / Fleece Jackets Navy Blue Track Suit Girls : Navy Blue short pants School T-Shirt / White Golf T-Shirt Maroon Jersey / Fleece Jackets Navy Blue Track Suit Uniform should be worn fully from Monday to Friday except on civies day. Page 5

7 It is compulsory that this form be COMPLETED AND RETURNED to the school LOMPEC PRE SCHOOL - CONFIRMATION OF ADMISSION TO SCHOOL SCHOOL FEES COMMITMENT I, the undersigned, ID of physical address: (chosen domicilium citandi et executandi) Tel. (H) (W) (Cell) hereby declare that I am truly and lawfully indebted to LOMPEC PRE SCHOOL in the amount of for R school fees due for 20..., for my child / children. (Amount in words) Seven Thousand Seven Hundred Rands I hereby undertake to make all payments to the school as follows: Tick the appropriate block) Monthly payments (on or before the 4 th of every month). 10% discount will be allowed if the total fees are paid before 31 st January. Direct Banking (request banking details in Admin Office). Internet Banking. (Learner's Name and details of payment must be entered on Internet / Deposit Slip and a copy forwarded to the school). Debit Order (Make arrangements with your bank timeously). EFT Payments Services are available at the school. NB: Please state NAME OF LEARNER on deposit slips when using direct banking method Name of Child Grade 4 Fees are payable over a period of ELEVEN MONTHS February to December. In the event of my failing to pay any instalment payable under this acknowledgement on due date, the full balance of such capital, interest and legal costs shall immediately be due and payable without further notice. I agree to the jurisdiction of the Magistrate s Court. I hereby consent to pay all costs on an attorney and own client scale, (including collection charges) incurred by the school for recovery of any indebtedness to herein. All payments made in terms hereof shall be appropriated first to legal costs and collection charges, then interest and thereafter to capital. SIGNED AT ON THE DAY OF SIGNATURE OF PARENT/GUARDIAN AS WITNESSES: Page 6

8 Reg No.2008/010115/08 LOMPEC PRE SCHOOL ( LOMPEC EDUCATION CENTRE ) ( ASSOCIATION INCORPORATED UNDER SECTION 21 ) Ledwaba Street P. O. Box P.O. Rethabile Mamelodi Mamelodi East TEL : (012) EMIS No.: lompec@icon.co.za FAX : (012) NPO No.: website: =========================================================================== INDEMNITY FORM I being Parent / Guardian of accept that all reasonable precautions will be taken to ensure the safety and welfare of my child, and that I shall be responsible for the payment of medical and/or other hospital accounts, where applicable, should an injury be sustained. I also declare that the school and staff cannot be held liable, and are indemnified against loss of any personal articles of clothing, toys etc, brought to the school, or any personal injury or death howsoever arising. I hereby consent to my child going on outings during the period that he/she is at this school, and indemnify the school and staff against any claim that may arise. The Lompec Management Board reserves the right to amend the rules and regulations where the need arises. Signed this... day of at... Father/Guardian :... Mother/Guardian... Witness Page 7