Preferred campus:(Required) Somerset West Paardevlei Preferred date for admission:(Required) DD slash MM slash YYYY Childs Personal Details:First Name:(Required) Surname:(Required) Home Language:(Required) Birthdate:(Required) DD slash MM slash YYYY Gender: Male Female Previous school attended:(Required) 1st Primary School of choice(Required) 2nd Primary School of choice:(Required) Number of Children in the family:(Required) Is the child 1st, 2, 3 in the family:(Required) Parents Details:Fathers Details:Mothers Details:Name(Required) First Last Name(Required) First Last Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Telephone Number:Telephone Number:Cell Number:(Required)Cell Number:(Required)Email:(Required) Email:(Required) Occupation:(Required) Occupation:(Required) Work Number:(Required)Work Number:(Required)Address of employement(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Address of employement(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Date of submission(Required) DD slash MM slash YYYY Date of submission(Required) DD slash MM slash YYYY ID Number of Father:(Required) ID Number of Mother:(Required) Marital Status(Required) Married Divorced Single Marital Status(Required) Married Divorced Single Where does the child reside?(Required) GeneralAllergies:Any serious illnesses: (Asthma, epilepsy, etc)Childhood illnesses that your child already has had:Measles:(Required) Yes No German Measles:(Required) Yes No Chicken Pox:(Required) Yes No Mumps:(Required) Yes No Whooping cough:(Required) Yes No Scarlet Fever:(Required) Yes No Diphtheria:(Required) Yes No My child has had other illnesses:(Required) Yes No Please list the other illnesses your child already has had:Chronic medication that needs to be given at school:(Required) If none please list "none"Operations your child has had:(Required) If none please list "none"Any assistance in the following:Occupational Therapy:(Required) Yes No Physio Therapy:(Required) Yes No Remedial Therapy:(Required) Yes No Psychology:(Required) Yes No Problems in connection with:Hearing:(Required) Yes No Eye Sight:(Required) Yes No Speech:(Required) Yes No Teeth:(Required) Yes No Describe your child's eating/drinking habits:(Required)What time does your child go to bed?(Required) Hours : Minutes Describe your child sleeping habits (Calm, restless, nightmares):(Required)Are there any signs of anxiousness during the day or night?(Required) Yes No Please provide a brief description:Does your child play indoors or outdoors?(Required) What is your child's preferred toys?(Required) Please give a brief description of your evening routine,if you have one:Stories read at home:(Required) All the time Occasionally Never Interest in Music and Art(Required) Music Art Check all personality traits of your child:(Required) Well behaved Misbehaved Selfish Moody Responsible Careless Shy Introverted Extroverted Outgoing Loving Aggressive Tolerant Confident Unselfish Irritable Frustrated stubborn Self-confidence(Required) Too Much Too Little Average Responds to instruction:(Required) Well Not Well School participationMothers willingness to participate in school functions:(Required) Very Moderately Not at all Fathers willingness to participate in school functions:(Required) Very Moderately Not at all Consent(Required) The mother and father gives their conentWe consent that the above information is correct and this consent acts as a digital signature for both parents of the child in question. I/we hereby also agrees that Jelly Babies may do a Credit Enquiry on both Parents to ascertain payment Integrity.
