REGISTRATION FORM. 18 Kerk Street Kuilsriver Tel:

Transcription

1 REGISTRATION FORM 18 Kerk Street Kuilsriver Tel: admin@juniorcampus.co.za

2 Hannelie van Zyl Opvoedkundige Dienste 18 Kerk Street, Kuilsriver, 7580 Tel/Fax : chery@juniorcampus.co.za Reg no. 2001/052469/23 APPLICATION FOR ADMISSION DOCUMENTATION REQUIRED BY THE SCHOOL FOR OFFICE USE Mother s ID Document Copy of Birth Certificate 2 Passport/ID photo s (colour) Father s ID Document Copy of Vaccination Record Signed General Indemnity Form Proof of Residential Address 6 Year Injection Issued Signed Financial Terms & Conditions Copy of Medical Aid Card Copy of Latest Report Signed General Info & Rules FEE STRUCTURE Registration R Aftercare R Potty R Daily fee R Full day R Half day R Referred by : FOR OFFICE USE DATE APPLICATION WAS RECEIVED : APPLICATION APPROVEL DATE : APPLICATION NUMBER : CLASS : COMMENCEMENT DATE : FOR OFFICE USE COMMENTS : IF LEARNER WILL BE MAKING USE OF TRANSPORT, PLEASE FILL IN TRANSPORTS PERSON S DETAILS AND ATTATCH COPY OF PDP : NAME AND : CONTACT DETAILS OF DRIVER : MAKE AND MODEL OF VEHICLE: LICENCE AND REGISTRATION: ALTERNATIVE DRIVER: SECTION A : LEARNER S DETAILS FULL NAMES (as on birth certificate) DATE OF BIRTH (DD/MM/YYYY) AGE (YEARS / MONTHS) GENDER GRADE APPLIED FOR YEAR APPLIED FOR

3 SECTION A : LEARNER S DETAILS FULL NAMES (as on birth certificate) DATE OF BIRTH (DD/MM/YYYY) AGE (YEARS / MONTHS) GENDER GRADE APPLIED FOR YEAR APPLIED FOR HOME LANGUAGE LANGUAGE OF INSTUCTION RELIGION : NO. OF CHILDREN IN FAMILY : POSITION OF LEARNER IN FAMILY : NATIONALITY : COUNTRY OF ORIGIN : SECTION B : MEDICAL INFORMATION ALLERGIES : SPECIAL NEEDS : FAMILY DOCTOR : (NAME AND ) CONTACT NO. MEDICAL AID SCHEME : MEDICAL AID CARD NUMBER : Has the learner received all the necessary immunizations? YES NO If not, please specify which immunizations were not received including reason : Please specify if the learner has suffered from the following illnesses (please indicate with an X) Asthma Measles Tick bite Fever Chicken Pox German Measles Diphtheria Diabetes Mumps Whooping Cough Malaria Polio Epilepsy Tuberculoses (Law abiding to entry of school) BLOOD TYPRE O+ O- A+ A- AB+ AB- B+ B- UNKNOWN

4 SECTION C : MEDICAL INFORMATION Does the learner suffer from any other illnesses or disabilities or has the learner suffered from any other illnesses or disability? YES NO If yes, please specify details : Is the learner receiving medical treatment for any conditions? YES NO If yes, please specify details : Has the learner suffered from or been treated for any psychological or emotional upset? YES NO If yes, please specify details : Has the learner had any medical operations? YES NO If yes, please specify details : Should there be any other vital relevant information which is necessary, please specify : SECTION D : DETAILS OF EMEGENCEY CONTACT HOLDER : in the event that you are not able to collect your child please supply an allowed list. (please remember that names listed below must be accompanied by copy of id document) PERSON 1 FULL NAMES AND (as on identity book) RELATIONSHIP PERSON 2 FULL NAMES AND (as on identity book) RELATIONSHIP PERSON 3 FULL NAMES AND (as on identity book) RELATIONSHIP

5 SECTION E : DETAILS OF FATHER / STEPFATHER / GUARDIAN FULL NAMES (as on identity book) RELATIONSHIP : MARITAL STATUS : _ OCCUPATION : EMPLOYER : ADDRESS 1 RESIDENCE ADDRESS 2 - WORK ADDRESS 3 POSTAL CODE CODE CODE TEL. HOME : TEL. WORK : CELL : (PLEASE WRITE LEGIBLY AND CORRECT CAPS) PARENTAL STATUS : LEARNER IS LIVING WITH PARENT LEARNER S LEGAL GUARDIAN ACCESS RIGHTS TO LEARNER ACCESS RIGHTS IN AN EMERGENCY ONLY SECTION F : DETAILS OF MOTHER / STEPMOTHER / GUARDIAN FULL NAMES (as on identity book) RELATIONSHIP : MARITAL STATUS : _ OCCUPATION : EMPLOYER : ADDRESS 1 RESIDENCE ADDRESS 2 - WORK ADDRESS 3 POSTAL CODE CODE CODE TEL. HOME : TEL. WORK : CELL : (PLEASE WRITE LEGIBLY AND CORRECT CAPS) PARENTAL STATUS : LEARNER IS LIVING WITH PARENT LEARNER S LEGAL GUARDIAN ACCESS RIGHTS TO LEARNER ACCESS RIGHTS IN AN EMERGENCY ONLY

6 SECTION G : DETAILS OF ACCOUNT HOLDER FULL NAMES (as on identity book) RELATIONSHIP : MARITAL STATUS : _ OCCUPATION : EMPLOYER : ADDRESS 1 RESIDENCE ADDRESS 2 - WORK ADDRESS 3 POSTAL CODE CODE CODE TEL. HOME : TEL. WORK : CELL : (PLEASE WRITE LEGIBLY AND CORRECT CAPS) SECTION H : DECLARATION OF ACCOUNT HOLDER I, the undersigned, hereby certify that the Information given by me on this application is complete and accurate. We accept liability for the due and punctual payments of all school fees (which are non-refundable) or any other amounts which may become due and payable to Junior Campus or in respect of participation in or attendance of any extracurricular activity. I accept the Financial Terms and Conditions. NB. The signature of the account holder as well as that of the 2nd parent is required.. SIGNATURE OF ACCOUNT HOLDER SIGNATURE OF 2 ND PARENT SIGNATURE OF A JUNIOR CAMPUS REPRESENTATIVE _ DATE _ DATE _ DATE

7 SECTION I : DETAILS OF EMEGENCEY CONTACT HOLDER : in the event that we are not able to get hold of a legal guardian, please supply a third contact number who is authorized to give consent on your behalf. FULL NAMES (as on identity book) RELATIONSHIP : TEL. HOME : TEL. WORK : CELL : (PLEASE WRITE LEGIBLY AND CORRECT CAPS) SECTION J : MEDICAL CONCENT NB : IN A CRITICAL SITUATION, PLEASE BEAR IN MIND THAT THERE MAY NOT BE TIME TO REFER TO YOUR CHILD S RECORDS. THE SCHOOL THEREFORE RESERVES THE RIGHT TO UTILISE THE QUICKEST MEDICAL SERVICE AVAILABLE. I, being the parent/legal guardian of Hereby agree that the appointed Junior Campus practitioner may carry out emergency treatment as may be necessary. SIGNATURE OF PARENT / GUARDIAN: DATE: SECTION K : DECLARATION We, the undersigned, hereby certify that the Information given by us on this application is complete and accurate. We agree to the conditions as set out below. We accept that the school is based on Christian principles and undertake not to undermine this position. The learner s application will be reconsidered in the case where relevant, important information, which was to be brought to the schools attention, was withheld during the application process. We have read the JUNIOR CAMPUS CONSTITUTION and CODE OF CONCUCT NB. The signatures of both parent and / or guardians are required. SIGNATURE OF FATHER / STEPFATHER / GUARDIAN _ DATE SIGNATURE OF MOTHER / STEPMOTHER / GUARDIAN _ DATE

8 Hannelie van Zyl Opvoedkundige Dienste 18 Kerk Street, Kuilsriver, 7580 Tel/Fax : chery@juniorcampus.co.za Reg no. 2001/052469/23 FINANCIAL TERMS AND CONDITIONS 1. ACCEPTANCE OF LIABILITY 1.1. The person/s responsible for the account (hereafter the responsible person ) as set out in the standard Junior Campus Application for Admission ( the Application Form ) herewith assumes liability for the account, alternatively binds himself as co-debtor and surety for payment of all school fees to Junior Campus ( the School ) 1.2. The guardian, as described in the Application Form, binds himself as surety and co-debtor for the payment of all school fees by the responsible person or any other payments that may arise from this agreement. 2. TERMS OF PAYMENT 2.1. It is recorded that school fees are adjusted at the end of August each year with approximately 10%.(Initial) 2.2. School fees for 12 months are payable before/on the first of each month in advance by the responsible person in the Application Form. (Initial) 2.3. This is an ongoing contract, in other words should your child be absent from school due to holiday / sickness / etc. you will be accountable for school fees during the period of absence. (Initial) 2.4. Payments are to be made via direct deposit, internet, or debit order into the schools account without any deductions. Proof of payment is to be ed, faxed or handed in to the school. (Initial) 2.5. All school fees have to be paid upfront before or on the first of every month. No deposits or any other amounts are redeemable. (Initial) 2.6. The School reserves the right to charge admin fee of R50.00 per day should fees not settled paid by the 3 rd of every month (Initial) 2.8. All learners who enter into Junior Campus are required to pay the following required fees before the application can be successful. Once off registration fee, as well as the starting months fee upfront. All payments are none refundable once paid into the schools account All existing payments are to be paid into the schools account no later than 15 December for the month of January. Late payments will be charged admin fee of R50.00 per day. This includes new and existing learners for the following year. (Initial) When registering you child/-ren at Junior Campus, you need to pay R registration fee as well as one month s school fees. 3. BREACH OF CONTRACT 3.1. In the event where the undersigned surety, responsible person or guardian commits a breach of contract of any of the term of this agreement, the school may in its sole discretion : Refuse the scholar entry to the School s premises until the breach has been remedied; or Claim damages from the responsible person and / or the sureties and guardian Take whatever legal steps that may be necessary. 4. GENERAL This Agreement constitutes the whole Agreement between the parties relating to the subject matter hereof. No amendment or consensual cancellation of this Agreement or any provision or term thereof or of any Agreement, bill of exchange or other document issued or executed pursuant to or in terms of this Agreement and no settlement of any disputes arising under this Agreement and no extension of time, waiver or relaxation or suspension of any of the provisions or terms of this Agreement or of any Agreement, bill of exchange or other document issued pursuant to or in terms of this Agreement shall be binding unless recorded in a written document signed by the parties. Any such extension, waiver or relaxation or suspension which is so given or made shall be strictly construed as relating strictly to the matter in respect whereof it was made or given. 5. LEGAL FEES In the event where the School takes legal action against the responsible person he will be liable for all legal fees on an attorney client scale, collection costs and commission, interest and tracing fees. 6. CANCELLATION 6.1. The responsible person undertakes to give two months written notice of termination of the enrolment of a learner on the school s termination of contract form, failing which the liability be incurred for the full amount of the following two months fees Junior Campus shall be entitled to terminate the Enrolment of any scholar under the following circumstances Summarily, and with immediate effect, if the learner is guilty of an offence which, in the sole opinion of the School renders his continued enrolment at the School impossible, in which event the responsible person, after deduction of all amounts otherwise owing to the School, will be refunded a pro-rata proportion of any Fees already paid in advance in respect of such learner. (Initial) SIGNED AT ON THIS. DAY OF 20. SIGNATURE OF PARENT/GUARDIAN SIGNATURE OF ACCOUNT HOLDER DATE.. DATE..

9 Hannelie van Zyl Opvoedkundige Dienste 18 Kerk Street, Kuilsriver, 7580 Tel/Fax : chery@juniorcampus.co.za Reg no. 2001/052469/23 GENERAL INDEMNITY FORM The School and the Owners, Principal and Staff undertake to implement reasonable and generally acceptable measures with regard to the safety and well being of all learners, educators and visitors to our School. Due to the nature of the matter, the Owner, Principal and Staff can, however, not accept any responsibility for accidents that may take place in the class, on the school terrain or on the play fields. Each parent is therefore requested to complete this form as proof that you accept the position of the School and the Owner, Principal and Staff as set out above as well as the risks involved therewith. I, the undersigned, FULL NAMES AND : _ (PARENT) ADDRESS : Tel : being the parent of guardian of the under mentioned learner/s who is /are enrolled as such and accepted by Junior Campus, subject to the terms set out herein : FULL NAMES AND : (LEARNER) Indemnify Junior Campus, the Owners, Principal and Staff for any losses or damages in general, however it may occur, that I as parent or guardian of the above learner may suffer as a result of any occurrences whereby my child may be involved, whether as the causing or suffering party, whilst participating in any school activity. In particular, I authorize that my aforesaid child may be involved in all excursions undertaken by his or her group or class during school days as part of his/her learning experience and where applicable I agree that he/she may utilize the transport arranged by the School for such excursions. I also indemnify the School, Owner, Principal and Staff for damages or losses I as parent or guardian of the above learner may suffer under such circumstances and voluntarily accept the risk associated therewith. In the event of the aforesaid child making use of the bus service to and from the school, I acknowledge that I am aware that such service is operated by an independent contractor and that neither the School, nor the Owner, Principal and Staff accept any responsibility therefore. (the Owner, Principal, will however, in awarding the right to operate the service, laid down certain conditions to ensure that the bus company complies with safety regulations and that the driver is sober and experienced with a proven and unblemished record.) SIGNED AT ON THIS DAY OF 20 PARENT / GUARDIAN (Name Print) PARENT / GUARDIAN ( Sign)

10 Hannelie van Zyl Opvoedkundige Dienste 18 Kerk Street, Kuilsriver, 7580 Tel/Fax : chery@juniorcampus.co.za Reg no. 2001/052469/23 GENERAL INFORMATION AND RULES 1. Contact the school immediately regarding any enquiries / complaints or suggestions. 2. Children have to be dropped off at school clean and properly dressed. 3. Remember to complete the medicine register in full and to remove all medicine from your toddler s bag and hand in at the office. 4. Kindly keep your child at home in the event of any serious or contagious infections, illnesses, i.e., measles, mumps, tonsillitis, lice, etc. Should a learner have a contagious infection, the learner is to bring a certificate from a medical doctor informing the school that the learner is fit to attend school again. No learner will be allowed back until a clearance certificate has been received. 5. All of your children s belongings have to be marked clearly. Junior Campus will not be held responsible for lost items. Should an item be missing, we ask that you contact the school immediately. 6. The office hours of Junior Campus are from 06h30 18h00. A penalty will be applicable should you collect your child later than the said office hours. You will be charged R10.00 per minute 7. This is an ongoing contract, in other words, should you child be absent from school due to holiday, sickness, etc., you will be hold accountable for school fees during the period of absence. 8. We would like to inform parent that Junior Campus makes use of social media. Junior Campus reserves the right to use images for marketing or letters. 9. Junior Campus reserves the right of admission. Should a parent or learner behave in an unacceptable manner they will be given notice with immediate effect. 10. Permission is granted for an occupational therapist to assess your child and help further your child s development and progress. 11. Should an aftercare parent not inform the school of the learner s absence, R fine will be invoiced onto your account. 12. As of 21 January 2015, all parents are required to sign out learners. No learners may leave the premises of Junior Campus without the roster filled in. It is the parent s responsibility to contact the school should someone else be collecting a child who is not on the allowed list. A child may not collect a child and a parent must get out of the car and come in to collect learners. Should a learner make use of transport, it is the driver s responsibility come in and collect the learner. Should the above not be adhered to, a fine of R per offence will be invoiced to your account. The above rule is set for the safety of your child. Toiletry Requirements (Quarterly) Grade R Requirements Toddler Requirements 5 x Toilet rolls 1 x Ream A 4 or A 3 white paper ( 500 Sheets ) 1 x Ream plain white paper (500 sheets) 1 x Liquid hand soap 1 x Bright / Pastel assorted colour paper ( 50 sheets ) 1 x Bright assorted colour paper (50 sheets) 1 x Air freshener 10 x Black colour sheets 1 x Box tissues 1 x Ring file neatly covered with bright paper and plastic, please don t forget to put your child s name and surname on. 1 x Wet wipes large packet 1 x 50 Page Flip file 1 x A4 plastic folder 30 x Plastic sleeves 1 x 50 Page flip file General Requirements 1 x Black White board marker 1 x Cot mattress ( 115cm x 54cm) 2 x 12 Pack Mon-Ami crayons (not for Grade R learners) Cot fitted sheet ( 115cm x 54 cm) 1 x Pack Mon Ami or Pentel oil pastels 2 x Mon Ami retractable crayons (12 pack) Light fleece blanket (winter only) 1 x 12 Pack Thick Koki s Full extra set of marked clothes 1 x Thick wax crayons 1 x Thick Jumbo wax crayons (12 pack) Snack box and cool drink for snack time 1 x Blunt scissors 1 x Blunt scissors 2 x Big Pritt glue (40g) 2 x Big Pritt glue (40 g) 2 x Alcolin cold wood glue ( Pritt or Bostik ) 2 x Alcolin cold wood glue ( Pritt or Bostik ) 1 x Thick children s art paint brush (no. 18) 1 x Thick children s art paintbrush (no. 18) 1 x A4 hard cover 192 pages book 1 x A4 hard cover 192 pages book Empty 2L ice cream bowls ( as many as you can send ) If you neglect to forward these toiletries it will be accredited to your account. Should your child require a replacement from any of the above mentioned, the class teacher will send out a request for the item to be replaced via the monthly letter. I fully comprehend and understand the rules of Junior Campus and will abide to these rules. SIGNED AT ON THIS DAY OF 20 PARENT ( Name Print) PARENT ( Sign)

11 Hannelie van Zyl Opvoedkundige Dienste 18 Kerk Street, Kuilsriver, 7580 Tel/Fax : chery@juniorcampus.co.za Reg no. 2001/052469/23 Toiletry Requirements (Quarterly) Grade R Requirements Toddler Requirements 5 x Toilet rolls 1 x Ream A 4 or A 3 white paper ( 500 Sheets ) 1 x Ream plain white paper (500 sheets) 1 x Liquid hand soap 1 x Bright / Pastel assorted colour paper ( 50 sheets ) 1 x Bright assorted colour paper (50 sheets) 1 x Air freshener 10 x Black colour sheets 1 x Box tissues 1 x Ring file neatly covered with bright paper and plastic, please don t forget to put your child s name and surname on. 1 x Wet wipes large packet 1 x 50 page flip file 1 x A4 plastic folder 30 x Plastic sleeves 1 x 50 Page flip file General Requirements 1 x Black White board marker 1 x Cot mattress ( 115cm x 54cm) 2 x 12 Pack Mon-Ami crayons (not for Grade R learners) Cot fitted sheet ( 115cm x 54 cm) 1 x Pack Mon Ami or Pentel oil pastels 2 x Mon Ami retractable crayons (12 pack) Light fleece blanket (winter only) 1 x 12 Pack Thick Koki s Full extra set of marked clothes 1 x Thick wax crayons 1 x Thick Jumbo wax crayons (12 pack) Snack box and cool drink for snack time 1 x Blunt scissors 1 x Blunt scissors 2 x Big Pritt glue (40g) 2 x Big Pritt glue (40 g) 2 x Alcolin cold wood glue ( Pritt or Bostik ) 2 x Alcolin cold wood glue ( Pritt or Bostik ) 1 x A4 hard cover 192 pages book 1 x A4 hard cover 192 pages book 1 x Thick children s art paint brush (no. 18) 1 x Thick children s art paintbrush (no. 18) Empty 2L ice cream bowls ( as many as you can send ) If you neglect to forward these toiletries it will be accredited to your account. Bank Details Account Holder: HvZ Opvoedkundige Dienste Bank : ABSA Bank Kuils River Account: Cheque Account Account Number: Branch Code: Ref: Childs name/surname JC code Please don t forget to send proof of payment (accounts@juniorcampus.co.za)