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for Hostel
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Learner Information
Grade applied for:
Year applied for:
Highest Grade Passed
Year when grade was passed
Accession No
First Name
Last Name
Initials
Nick Name
Other Names
Date Of Birth
Gender
Race
Identification Number
Country of Residence
Citizenship
If SA, indicate province of residence
Physical Address
City/Suburb
Code
Home Telephone
Emergency Telephone
Learner Cell
Learner Email Address
Home Language
Preferred Language of Instruction
Boarder
Deceased Parent
Mode of transport
Religion
Dexterity of learner
For Grade 1 only
Additional Information
Academic Achievements
Extramural Activities
REASONS for placing the child / children in a hostel:
Does your child have any medical condition that we need to know of?
Does your child have a bedwetting problem?
Does your child take any chronic medicine that we have to administer through the week:
Is your child allergic to any medicine?
Is your child allergic to any food?
I
to my child reasonably participating in the extramural activities of the School and Hostel.
Medical Information
Medical Aid Number
Medical Aid Name
Medical Aid Main Member
Doctor Name
Doctor Address
Doctor Number
Medical Condition
Special Problems Requiring Counseling
Reg. Social Grant
Contact details of present school
Name of previous school
Previous school address
Province
Country
Postal Code
Contact Person Details
Parent/Legal Guardian/Proxy Information
First Name
Last Name
RSA-Citizen
Identification Number
Home Tel:
Work Tel:
Cell no
Email
Occupation
Employer
Material Status:
State whether parent/legal guardian/proxy.
Home Address
Address
Apartment,Suite,etc.
City
Province
Country
Postal code
Work Address
Address
Apartment,Suite,etc.
City
Province
Country
Postal code
Please submit the following documents:
Acknowledgement
Name
Surname
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