FAIRHAVEN PRIMARY SCHOOL
36 Lenny Naidu Drive, Chatsworth, 4092 | Tel: 031 400 3933
OFFICIAL APPLICATION FOR ADMISSION
A. ADMISSION DETAILS
Grade:
Year:
Term:
Highest Grade:
Year Passed:
Accession No: ____________
B. LEARNER PERSONAL DETAILS
Surname:
First Names:
Initials:
Nickname:
Other:
DOB:
ID:
Gender:
Race:
Citizenship:
Country:
Physical Address:
Country:
Province:
Home Tel:
Emergency:
Learner Cell:
Home Lang:
Pref Lang:
Religion:
Boarder:
Transport:
Deceased:
E. PREVIOUS SCHOOL
Name:
Address:
Postal Code:
Prov:
Country:
F. MEDICAL INFORMATION
Aid Name:
No:
Member:
Doctor:
Tel:
Addr:
Condition:
Problems:
Dexterity:
G & H. GENERAL
Reg. Grant:
Rec. Grant:
Siblings:
I. PARENT / GUARDIAN 1
Name:
ID:
Title:
Cell:
Email:
Address:
Occ:
Employer:
Payer:
SPOUSE
Name:
Occ:
ID:
Work:
Cell:
PARENT 2
Name:
Rel:
Cell:
Address:
J. CORRESPONDENCE
Name:
Address:
Home:
Fax:
Work:
Cell:
Email:
L. DECLARATION
I, the undersigned, hereby declare that the information supplied is true and correct. I give permission to Fairhaven Primary School to process my personal information and that of the learner in accordance with the Protection of Personal Information Act (POPIA) for admissions, communication, and learner management purposes.
Signed:
Date:
OFFICE USE ONLY
1. Date: __________
2. Accepted: Y / N
3. Rejected: Y / N
Reason: __________________________________________________
Documents:
[ ] Birth Cert
[ ] Clinic Card
[ ] Parent IDs
[ ] Report
[ ] Proof Res