Enroll my Child

Preferred campus:*

Somerset West
Paardevlei

Preferred date for admission:*

Childs Personal Details:

First Name:*

Surname:*

Home Language:*

Birthdate:*

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:

Cell Number:*

Email:*

Occupation:*

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*

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:*

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.

I/we hereby also agrees that Jelly Babies may do a Credit Enquiry on both Parents to ascertain payment Integrity.

CAPTCHA

To Enroll your child with Jelly Babies please fill out the form below:

Childs Personal Details:

Parents Details:

Fathers Details:

Mothers Details:

General

Allergies:

Childhood illnesses that your child already has had:

Any assistance in the following:

Problems in connection with:

School participation