Admission Application Form Applicant Details:First NameMiddle NameLast NameGender of the Child (Learner)MaleFemaleOtherDate of Birth *Street AddressApartment, suite, etcCityState/ProvinceZIP / Postal CodePrimary Contact Number (Cellphone)Alternative Contact NumberEmail Address *Any contact person (Relative not living with family)First NameSurnameRelationship with to familyContact NumberEmail Address *Full Name of Guardian/ParentFirst NameLast NameGuardian's Relationship to ChildGuardian’s OccupationEmployer’s Contact DetailsCompany NameContact NumberEmail Address *Parent(s) StatusAliveDeceasedSchool InformationSelectType of ApplicationPrimary School (Grade RR - 7)College (Grade 8 - 12)Select the branch: Grade RRGrade 1Grade 2Grade 3Grade 4Grade 5Grade 6Grade 7For Primary SchoolSelect the grade: (Grade RR – 7)Grade RRGrade 1Grade 2Grade 3Grade 4Grade 5Grade 6Grade 7Northam BranchSelect the grade:(Grade 8-12)Grade 8Grade 9Grade 10Grade 11Grade 12For College (Grade 8-12)Do you require transport from Thabazimbi to Northam?NoYesHealth Information:Choose FileNo file chosenDelete uploaded fileChild's Immunization Form (Attach document)Does the child have any allergies or health conditions the school should be aware of?YesNo(if Yes, please specify)Family Doctor Details (if available): Doctor’s NamePractice NameContact NumberPrevious School Details:Has the learner previously attended a different school?YesNoIf yes, attach the latest school report (for new Learners): Upload fileChoose FileNo file chosenDelete uploaded fileDeclaration of Health Details: I declare that the above health information provided is true and accurate to the best of my knowledge.I hereby acknowledge(Parents to acknowledge by ticking a box)Acknowledgement of Terms: I acknowledge that the information provided is true and complete.I hereby acknowledgeSignature of Parent/Guardian: This site is protected by hCaptcha and its Privacy Policy and Terms of Service apply.Send MessagePlease do not fill in this field.
