1. JBAY ACADEMY 4 KIDS Application Form 2015
LEARNER NAME:__________________________
GRADE: _________________________________

2. LEARNERS MEDICAL INFORMATION
APPLICATION FOR 2015
NON REFUNDABLE REGISTRATION FEE OF R450 PAYABLE ON SUBMISSION OF APPLICATION
NAME OF LEARNER:
GRADE APPLYING FOR:
CURRENT SCHOOL:
LEARNERS MEDICAL INFORMATION
MEDICAL AID:
MEDICAL AID NO:
MAIN MEMBER:
NAME OF GP:
GP TEL:
ALLERGIES:
IMMUNISATION:
SPECIAL MEDICAL PROBLEMS REQUIRING COUNSELLING:

3. PLEASE INCLUDE THE FOLLOWING
LEARNER DETAIL
FULL NAME AND SURNAME:
DATE OF BIRTH:
HOME LANGUAGE:
HOME ADDRESS:
PLACE OF CHILD IN THE FAMILY (1ST, 2ND, 3RD CHILD):
OTHER DETAIL
PLEASE INDICATE ANY APPROPRIATE INFORMATION IN THE FOLLOWING AREAS
PHYSICAL DISABILITIES:
LEARNING DISABILITIES:
SOCIAL DISABILITIES:
PLEASE INCLUDE THE FOLLOWING
COPY OF MOST RECENT SCHOOL REPORT
COPY OF ANY PROFESSIONAL REPORTS
COPY OF THE BIRTH CERTIFICATE

4. OTHER DETAIL MOTHER NAME: WORK ADDRESS: WORK TEL: CELL: EMAIL:
FATHER NAME:
WORK ADDRESS:
WORK TEL:
CELL:
EMERGENCY CONTACT (OTHER THAN PARENTS):
WHO WILL COLLECT THE CHILD AT THE SCHOOL:
TEL:

5. RESPONSIBILITIES OF THE LEARNER
SCHOOL FEES
Who will be responsible for the school fees:
Payment method
School fees are payable in advance by the 1st of each month.
The parents must be aware that the school fees are payable in respect of any and each individual academic school year (12 months).
SCHOOL FEES:
Parents are jointly and severely liable in the personal capacities for the payments of the school fees.
In event of the parents being in default of payment of the school fees-interest at the rate of 20% per annum will be levied on all such amounts which are due as calculated from the date upon which it became payable.
Legal steps will be instituted against them without prior notification for the recovery of such arrear fees in which event the parents will be liable for all legal costs and expenses as between attorney and own client including such collection commission which may lawfully become due.
CASH
DEBIT
EFT
RESPONSIBILITIES OF THE LEARNER
LEARNER MUST BEHAVE IN ORDERLY MANNER
MUST ACCEPT DISCIPLINE WHICH IS NECESSARY FOR THE GOOD FUNCTIONING OF THE ACADEMY
ATTEND ACADEMY FAITHFULLY
(if not parents are to inform us by either telephone or )
NAME OF PARENT NAME OF PARENT
_____________________ ______________________
SIGNATURE OF PARENT SIGNATURE OF PARENT
_____________________ _______________________
DATE ______________ SIGNATURE OF JBAY ACADEMY ______________________