Application of Enrolment 2017 Acts House of Education 187 Allan Glen Austin, Midrand Tel: 010 035 1031 E-mail: admin@actseducation.co.za Web: www.actseducation.co.za Office use only: Full Name and Surname of Learner: Family Code: Grade: 000 00 R 1 2 3 4 5 6 7 8 9 10 11 12 Date of Acceptance: Date of Admission: Date of Departure: Reason for Departure: Termination of Contract / Gr 7 Graduation / Grade 12 Graduation
Dear Parents, Thank you for expressing your interest in Acts House of Education. In order to ensure full completion of the application process, please use the following checklist to navigate your way through our application document: SECTION A: Student Information SECTION B: Parent/Guardian Information SECTION C: Medical Information SECTION D: Fee Policy & Account SECTION E: Contract (Only to be signed upon acceptance of the student) Please take note: Your application to Acts House of Education is subject to the full completion of this document and will only be processed once it is signed and initialed by both parents/guardians. All admissions are subject to the receipt of the necessary documentation and full payment of the applicable registration fees. Acts House of Education is a private entity that holds the right of admission by discretion of its Board of Directors. Aliquam The following documents must be included in your application: Copy of your child s ID document or Birth Certificate Copy of both parents and accountable person s ID Document (or passport with permit) Copy of your child s latest school report Copy of your child s immunization card Colour passport photograph of your child Proof of income & 3 months bank statements of the liable account holder Copy of medical aid card Latest Tuition Statement and School Report Card (of current school) A R500 non-refundable administration fee You will be contacted as soon as your application has been processed. Upon consideration of your application, and prior to your child s admission to the school, you will be required to sign our school contract and pay a R5 000 non-refundable deposit and first month s installment of school fees. Please contact us at admin@actseducation.co.za should you require any further information. We trust that God will grant you the wisdom and provision you require, as you commit to the education of your child at Acts House of Education. Sincerely Acts House of Education Initial 2
SECTION A: Student Information Present Age and Grade Full Name Surname Preferred Name / Nick Name Date of Birth ID/Passport Number Nationality Religious Denomination Gender Male: Female: Ethnic Group Home Language Additional Language/s Requested Admission Date Requested Admission Grade Nr of Years in Admission Grade Pre-Primary Education Attended Gr 000: Gr 00: Gr R: Name & Grade of siblings at AHE 1 2 3 Name of Current School Contact Number of Current School Name and Surname of Contact Person Highest Grade in Current School Reason for Leaving Current School Full Settlement of Current School Fees Yes: No: Reminder: Include the Latest Tuition Statement & Latest School Report Card of your Child s Current School. Initial 3
Has your child ever: YES NO Been expelled Been Suspended Involved in a Disciplinary Hearing Refused admission to a school Advised to repeat a year If you answered YES to any of the above, please provide full details: (The school reserves the right to request an independent report where necessary) Does your child have: YES NO Physical Barriers to Learning Attend Occupational Therapy Attend Speech Therapy Receive Remedial Support Receive Emotional / Psycological Support If you answered YES to any of the above, please provide full details: (The school reserves the right to request an independent report where necessary) Initial 4
SECTION B: Parent/Guardian Information Particulars Father/Guardian 1 Mother/Guardain 2 Title Full Names Surname Initials Preferred Name ID Number Date of Birth Marital Status Home Language Cell Phone Number Home Phone Number E-mail Residential Address Postal Address Child living with parents Yes No Yes No Parent Occupation Employer Work Phone Number Employer Physical Address Church Membership Pastor s Name Pastor s Phone Nr Born Again Christian Yes No Yes No Initial 5
SECTION C: Medical Information Medical aid name Medical aid plan Medical aid phone number Medical aid member number Primary member Family doctor name: Family doctor phone number: Family doctor business address: Name & Surname Relation Contact Nr Medical Aid Family Doctor Emergency Contact Person (other than Parents/Guardians) Does your child have: YES NO A Chronic Illness An Allergy Use Chronic Medication If you answered YES to any of the above, please specify: Initial 6
Has your child ever had: YES NO Measels German Measels Mumps Chicken Pox Pertussis (Whooping Cough) Indicate any illness your child currently suffers from (Astma, Epilepcy etc.) Indicate any diffucilty with hearing or vision: Indicate any surgical procedures your child has undergone: Has your child been immunised against: YES NO Measels German Measels Tuberculosis Diphtheria Poliomyelitis Tetanus Pertussis (Whooping Cough) NB: Students should have been immunised against all of the above illnesses before school attendance. Immunisation against POLIOMYELITIS and TUBERCULOSIS (BCG) is legally COMPULSORY. Written evidence (stamped clinic card) is demanded when admitting a child to the school for the first time. Initial 7
SECTION D: Fee Policy & Account SCHOOL FEE POLICY Acts House of Education is a registered NPO that relies on the prompt payment of school fees and sundry items to uphold the operational functioning of the organization. 1. School fees are payable, in advance, before the 1 st day of each calendar month. Fees are payable by debit order, EFT or Credit Card. 2. The annual charge for school fees is spread over 11 or 10 monthly payments for your convenience and assistance. Therefore, please pay promptly, no later than the 1 st of each month. 3. Students are strictly prohibited to pay school fees at the office on their parents/guardians behalf. The school does not take responsibility for fees sent to school with the Students and will not issue a receipt. 4. A statement will go out on or before the 10 th day of each month, to update you on your balance or remind you of any outstanding amounts. 5. Accounts not paid within 30 days become subject to a Prime interest of 0.87% per month or 10.5% annually. A first notice of payment will be issued after 30 days. The same interest and a second notice apply to 60 days outstanding and a final notice upon 90 days outstanding. Thereafter, it will be handed over to the necessary legal authorities. During the 30-90 day period the debtor will be liable for all additional costs incurred related to the debt collection. 6. Any unpaid debit orders will be for your account to cover any costs incurred by the school. 7. The School reserves the right at any time to withdraw any of the services offered to your child and to exclude your child from attending the School in circumstance where in the School s opinion the account is in arrears and where no agreement regarding bringing the arrears account up to date has been made, it shall not be necessary to provide a term s notice in this regard. 8. A non-refundable registration fee of R500 per Student is payable with your application. 9. A non-refundable deposit of R5 000 is payable per Student upon acceptance. This Amount does not constitute any outstanding school fees. 10. A first installment of at least one months tuition fees per student is payable upon acceptance. 11. If you wish to remove your child from the school, please note that a THREE CALENDAR MONTH S NOTICE PERIOD IS REQUIRED IN WRITING. You will be responsible for payment of school fees for this period even if the child leaves before the notice period is up. Any School records will not be forwarded to the new school until payment of all outstanding accounts is finalised. Initial 8
SCHOOL FEE STRUCTURE 2017 NEW ENROLMENT Registration Fee R 500 once off Non Refundable. Due with application form. Deposit R 5 000 once off Non Refundable. First Instalment Minimum of 1 Month s Tuition Fees Due Immediately Upon Acceptance. PAYMENT PLANS Tuition fees must be paid in advance before the 1 st day of every calendar month PLAN A Once Off (10% Discount on Annual Amount) Due: Before 31 January 2017 1 st Child 2 nd Child 10% discount 3 rd Child 15% discount 4 th Child 25% discount R 31 680 (Save R3 520) R 28 512 (Save R3 168) R 26 928 (Save R2 992) R 23 760 (Save R2 640) PLAN B 10 Months January October Due: 1 st of every month 1 st Child 2 nd Child 10% discount 3 rd Child 15% discount 4 th Child 25% discount R 3 520 R 3 168 R 2 992 R 2 640 PLAN C 11 Months January - November Due: 1 st of every month 1 st Child 2 nd Child 10% discount 3 rd Child 15% discount 4 th Child 25% discount R 3 200 R 2 880 R 2 720 R 2 400 PLAN D Termly Option 4 Payments Due: 1 January 2017 1 April 2017 1 July 2017 1 October 2017 1 st Child 2 nd Child 10% discount 3 rd Child 15% discount 4 th Child 25% discount R 8 800 R 7 920 R 7 480 R 6 600 Text Books & Work Books Once off: OTHER FEES Due: 1 January 2017 R 2 000 (per child) Two Payments: Due: 1 January 2017 Due: 1 July 2017 R 1 000 (per child) R 1 000 (per child) Grade R Workbooks & School Readiness Assessment Arts & Culture Fee Once off: Termly (4 Payments) Due: 1 January 2017 Due: 1 Jan, 1 Apr, 1 July & 1 Oct 2017 R 1 000 (per child) R100 (per child) Outings (Excursions & Incursions) Aftercare (This has been settled already by current parents). Termly (4 Payments) Monthly: Billed at R30 per day, from 13:15 17:30 Due: 1 Jan, 1 Apr, 1 July & 1 Oct 2017 Due: Billed on the 10 th of every month & payable immediately. Initial R200 (per child) (Outings billed on the actual cost: Max R200) Amount subject to attendance 9
BANKING DETAILS: Account Holder: Acts House of Education Bank: ABSA Account Type: Current Account Account Number: 4 085 042 398 Brance Code: 632005 Send all Proof of Payment to: admin@actseducation.co.za Reference: Student Name, Surname & Family Code (Example: JohnJones0053) PERSON ACCOUNTABLE FOR THE SETTLEMENT OF FEES: Title Full Name Surname Initials Preferred Name ID Number Home Language Cell Phone Number Home Number Work Number E-mail Residential address Postal address PERSON ACCOUNTABLE IN CASE OF A COMPANY/TRUST: Title Name Registration Number Contact Number Business Address Acts House of Education upholds to maintain a paperless environment. Therefore, all accounts and school communication will be managed via e-mail, telephone and text messaging. Initial 10
DEBIT ORDER INSTRUCTIONS: Date: From: (Name and Surname of Debtor as per ID document) (Address) Debtor Bank Account Details: Bank Branch Name: Branch Number/Code: Account Number: Account Type: Cheque Savings Transmission I/We hereby instruct and authorize Acts House of Education to draw against my/our account with the above mentioned bank (or any other bank or branch to which I/We may transfer my /our account) the amounts specified below on the 1 st day of each month commencing on or the 26 th day of each month commencing on and continuing (as the case may be). All such withdrawals from my/our bank account by Acts House of Education shall be treated as though they had been signed by me/us personally. Please select one of the folling options be included in your debit order payment per month: PLAN B: Monthly Tuition Fees over 10 months PLAN C: Monthly Tuition Fees over 11 months Textbooks/Workbooks: R2 000 (1 January) Textbooks/Workbooks: R1 000 x2 (1 January & 1 July) In addition to the monthly tuition fees, I authorise the debit order instruction to include Aftercare fees, Textbook & Workbook fees, Ars & Culture fee and Termly Outings as per the statement, as well as any other ancillary costs that has been pre-authorised in writing. I/We understand that the withdrawals hereby authorized will be processed by computer through a system known as the STRATCOL via Principal Primary, and I also understand that the details of each withdrawal will be printed on my bank statement. I/We agree to pay any bank charges related to this debit order instruction. This authority may be cancelled by me/us by giving Acts House of Education thirty days (30 days) notice in writing. I/we understand that I/we shall not be entitled to any refund of the amount which you have withdrawn while this authority was in force if such amounts were legally owing to you. Receipt of this instruction by you shall be regarded as receipt thereof by my/our bank. Assignment: I/We acknowledge that the party hereby authorized to effect the drawing(s) against my/our account may not concede or assign any of its rights to any third party without my/our prior written consent. I/ We may not delegate any of my/our obligations in terms of this contract authority to any third party without prior written consent of the authorized party. Note: A stamped bank statement for this account should be attached for bank identification purposes. Signed at on the day of 20. Name of Account Holder Signature of Account Holder Initial 11
CONSENT & INDEMNITY FOR VERIFICATION: FATHER/GUARDIAN 1 Surname: SA ID Number: Full First Name: Date of birth: Passport Nr: Physical Address: Verifications: Criminal Record: Have you ever had a previous conviction: YES NO If YES, Reason for conviction: Credit Checks: Fraud detection and fraud prevention services. Permission is granted to Acts House of Education to facilitate all relevant credit and criminal record checks. Indemnity: I hereby authorize Acts House of Education s duly authorized verification agent, to forward my personal information, including but not limited to my name, surname, identity number and fingerprints, to verification suppliers acting on behalf of the agent(including but not limited to SAPS, the Government of RSA, any educational, training, credit bureau and fraud prevention organisation). I authorize the agent to conduct all verification checks (including but not limited to credit bureau searches, drivers licenses employment history, employment salary verification and any other relevant checks in the pre- and post employment vetting process). I authorize the agent s suppliers to furnish personal information regarding my credentials, whether claimed or not, to the agent and The Acts House of Education. I unconditionally indemnify the agent and its verification information suppliers against any liability which results or may result from furnishing information in this regard. I understand that it is a condition of the South African Police Service and Tertiary Education Institutions, that: The information furnished to Acts House of Education and the agent will be disclosed to me for comment before a decision is made on my employment / application; and Acts House of Education is responsible for verifying the accuracy in respect of information furnished to the South African Police Service Consent: I, (full name and surname) hereby consent that, and authorises Acts House of Education to, at all times: Contact, request and obtain information from any credit or service provider (or potential credit or service provider) or registered credit bureau relevant to an assessment of the behaviour, profile, payment patters, indebtness, whereabouts, and creditworthiness of the applicant; Furnish information concerning the behaviour, profile, payment patters, indebtness, whereabouts, and creditworthiness of myself to any registered credit bureau or to any credit or service provider (or potential credit or service provider) seeking a trade reference regarding my dealings with Acts House of Education. I duly authorised signatory (name & surname) have read and understood all of the above. Signed at (place) on / / (date) Authorised signatory signature: Initial 12
CONSENT & INDEMNITY FOR VERIFICATION: MOTHER/GUARDIAN 2 Surname: Maiden Surname: SA ID Number: Full First Name: Date of birth: Passport Nr: Physical Address: Verifications: Criminal Record: Have you ever had a previous conviction: YES NO If YES, Reason for conviction: Credit Checks: Fraud detection and fraud prevention services. Permission is granted to Acts House of Education to facilitate all relevant credit and criminal record checks. Indemnity: I hereby authorize Acts House of Education s duly authorized verification agent, to forward my personal information, including but not limited to my name, surname, identity number and fingerprints, to verification suppliers acting on behalf of the agent(including but not limited to SAPS, the Government of RSA, any educational, training, credit bureau and fraud prevention organisation). I authorize the agent to conduct all verification checks (including but not limited to credit bureau searches, drivers licenses employment history, employment salary verification and any other relevant checks in the pre- and post employment vetting process). I authorize the agent s suppliers to furnish personal information regarding my credentials, whether claimed or not, to the agent and The Acts House of Education. I unconditionally indemnify the agent and its verification information suppliers against any liability which results or may result from furnishing information in this regard. I understand that it is a condition of the South African Police Service and Tertiary Education Institutions, that: The information furnished to Acts House of Education and the agent will be disclosed to me for comment before a decision is made on my employment / application; and Acts House of Education is responsible for verifying the accuracy in respect of information furnished to the South African Police Service Consent: I, (full name and surname) hereby consent that, and authorises Acts House of Education to, at all times: Contact, request and obtain information from any credit or service provider (or potential credit or service provider) or registered credit bureau relevant to an assessment of the behaviour, profile, payment patters, indebtness, whereabouts, and creditworthiness of the applicant; Furnish information concerning the behaviour, profile, payment patters, indebtness, whereabouts, and creditworthiness of myself to any registered credit bureau or to any credit or service provider (or potential credit or service provider) seeking a trade reference regarding my dealings with Acts House of Education. I duly authorised signatory (name & surname) have read and understood all of the above. Signed at (place) on / / (date) Authorised signatory signature: Initial 13
CONSENT & INDEMNITY FOR VERIFICATION: DEBTOR Surname: Maiden Surname: SA ID Number: Full First Name: Date of birth: Passport Nr: Physical Address: Verifications: Criminal Record: Have you ever had a previous conviction: YES NO If YES, Reason for conviction: Credit Checks: Fraud detection and fraud prevention services. Permission is granted to Acts House of Education to facilitate all relevant credit and criminal record checks. Indemnity: I hereby authorize Acts House of Education s duly authorized verification agent, to forward my personal information, including but not limited to my name, surname, identity number and fingerprints, to verification suppliers acting on behalf of the agent(including but not limited to SAPS, the Government of RSA, any educational, training, credit bureau and fraud prevention organisation). I authorize the agent to conduct all verification checks (including but not limited to credit bureau searches, drivers licenses employment history, employment salary verification and any other relevant checks in the pre- and post employment vetting process). I authorize the agent s suppliers to furnish personal information regarding my credentials, whether claimed or not, to the agent and The Acts House of Education. I unconditionally indemnify the agent and its verification information suppliers against any liability which results or may result from furnishing information in this regard. I understand that it is a condition of the South African Police Service and Tertiary Education Institutions, that: The information furnished to Acts House of Education and the agent will be disclosed to me for comment before a decision is made on my employment / application; and Acts House of Education is responsible for verifying the accuracy in respect of information furnished to the South African Police Service Consent: I, (full name and surname) hereby consent that, and authorises Acts House of Education to, at all times: Contact, request and obtain information from any credit or service provider (or potential credit or service provider) or registered credit bureau relevant to an assessment of the behaviour, profile, payment patters, indebtness, whereabouts, and creditworthiness of the applicant; Furnish information concerning the behaviour, profile, payment patters, indebtness, whereabouts, and creditworthiness of myself to any registered credit bureau or to any credit or service provider (or potential credit or service provider) seeking a trade reference regarding my dealings with Acts House of Education. I duly authorised signatory (name & surname) have read and understood all of the above. Signed at (place) on / / (date) Authorised signatory signature: Initial 14
SECTION E: Contract I/We the Parent(s)/Legal Guardian(s) of (Full Name of Student) agree to the admission of the above student to Acts House of Education on the following Terms & Conditions: 1. I/We have read, understood and agree to the conditions contained in the school Policies & Procedures Document received from the school/website. It is further understood that the aforementioned documentation may be reviewed annually. I/We have chosen the following method of accessing the documents: Hardcopy or Self-download from the School Website (www.actseducation.co.za). 2. I/We accept full liability of all school fees, aftercare and ancillary charges according to the school Payment Plan I/We have selected, which will become payable in terms of this agreement. 3. I/We agree to give 3 CALENDAR MONTH S NOTICE in writing, should I/We wish to withdraw the student from the school. Failure to give proper notice will result in me/us being liable for the payment of 3 full calendar months in lieu of such notice. It is the responsibilty of parents to provide timeous notice. 4. I/We agree to pay school fees and ancillary fees in accordance with the School Fee Structure per student and the Fees and Debtors Policy. 5. I/We have been notified of and agree to the school fees applicable to the aforementioned pupil and any ancillary cost which may be charged from time-to-time. I/we further acknowledge and concent that fees paid in advance will be deposited to the school and held in accordance with the provisions of the Consumer Protection Act of 2008. 6. I/We agree that non-payment of fees and/or ancillary charges will be deemed as a material breach of this contract and understand that I/We will be liable to pay interest and all other debtors costs inccured on the outstanding amount. 7. I /We agree and understand that the sibling discount on the school tuition fees is only applicable if the siblings are CONCURRENTLY at the school. 8. I/We understand that in the event of a material breach of this contract by me/us, the school reserves the right to terminate it after due process (as outlined in the Disciplinary Code) shall have been followed. I/we accept that the school has appointed certain suppliers and confirm that I understand the financial benefit to be derived by me through this arrangement in respect of price, quality control and branding. 9. I/We agree that this agreement will come into effect immediately on signature by me/us and shall apply for the full duration of the students enrolment at the school (unless early termination occurs by the party in terms of this contract) or until a new annual agreement supersedes this agreement. 10. I/We have completed and returned the application form to the school and accept the responsibility to any family details change in this document. 11. I/We consent to the school distributing my/our names and contact details only to other parents, staff or responsible persons engaged or authorised by the school for school related purposes, unless at anytime the school is instructed in writing by me/us differently. 12. I/We will maintain a partnership in education together with the teacher, by assisting and supporting teachers whenever necessary, to ensure that the student s progress is not hindered in anyway. 13. I/We will attend Parent/Teacher meetings to discuss student s academic progress. 14. I/We hereby accept admission to Acts House of Education and confirm that the information contained in this application is complete and accurate. 15. I/We understand that this document is the only and final contract with Acts House of Education. Full Name of Father/Guardian 1: Full Name of Mother/Guardian 1: Full Name of School Representative: Signature: Signature: Signature: Signed at (place) on / / (date) Initial 15