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021 850 0621
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Enroll my Child
To Enroll your child with Jelly Babies please fill out the form below:
Preferred campus:
*
Somerset West
Paardevlei
Preferred date for admission:
*
Date Format: MM slash DD slash YYYY
Childs Personal Details:
First Name:
*
Surname:
*
Home Language:
*
Birthdate:
*
Date Format: DD slash MM slash YYYY
Gender:
Male
Female
Previous school attended:
*
1st Primary School of choice
*
2nd Primary School of choice:
*
Number of Children in the family:
*
Is the child 1st, 2, 3 in the family:
*
Parents Details:
Fathers Details:
Mothers Details:
Name
*
First
Last
Name
*
First
Last
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Telephone Number:
Telephone Number:
Cell Number:
*
Cell Number:
*
Email:
*
Email:
*
Occupation:
*
Occupation:
*
Work Number:
*
Work Number:
*
Address of employement
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Address of employement
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Date of submission
*
Date Format: DD slash MM slash YYYY
Date of submission
*
Date Format: DD slash MM slash YYYY
ID Number of Father:
*
ID Number of Mother:
*
Marital Status
*
Married
Divorced
Single
Marital Status
*
Married
Divorced
Single
Where does the child reside?
*
General
Allergies:
Any serious illnesses: (Asthma, epilepsy, etc)
Childhood illnesses that your child already has had:
Measles:
*
Yes
No
German Measles:
*
Yes
No
Chicken Pox:
*
Yes
No
Mumps:
*
Yes
No
Whooping cough:
*
Yes
No
Scarlet Fever:
*
Yes
No
Diphtheria:
*
Yes
No
My child has had other illnesses:
*
Yes
No
Please list the other illnesses your child already has had:
Chronic medication that needs to be given at school:
*
If none please list "none"
Operations your child has had:
*
If none please list "none"
Any assistance in the following:
Occupational Therapy:
*
Yes
No
Physio Therapy:
*
Yes
No
Remedial Therapy:
*
Yes
No
Psychology:
*
Yes
No
Problems in connection with:
Hearing:
*
Yes
No
Eye Sight:
*
Yes
No
Speech:
*
Yes
No
Teeth:
*
Yes
No
Describe your child's eating/drinking habits:
*
What time does your child go to bed?
*
:
HH
MM
Describe your child sleeping habits (Calm, restless, nightmares):
*
Are there any signs of anxiousness during the day or night?
*
Yes
No
Please provide a brief description:
Does your child play indoors or outdoors?
*
What is your child's preferred toys?
*
Please give a brief description of your evening routine,if you have one:
Stories read at home:
*
All the time
Occasionally
Never
Interest in Music and Art
*
Music
Art
Check all personality traits of your child:
*
Well behaved
Misbehaved
Selfish
Moody
Responsible
Careless
Shy
Introverted
Extroverted
Outgoing
Loving
Aggressive
Tolerant
Confident
Unselfish
Irritable
Frustrated
stubborn
Self-confidence
*
Too Much
Too Little
Average
Responds to instruction:
*
Well
Not Well
School participation
Mothers willingness to participate in school functions:
*
Very
Moderately
Not at all
Fathers willingness to participate in school functions:
*
Very
Moderately
Not at all
Consent
*
The mother and father gives their conent
We consent that the above information is correct and this consent acts as a digital signature for both parents of the child in question.
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