2018 Information Form - Rosebank Primary

1 Rosebank Primary school 2018 Information form school DETAILS: Gauteng registration (EMIS) number: 700151456 Type of school : Sectional 21 DATE OF APPLICATION: _____ GRADE APPLYING FOR: _____ DETAILS OF LEARNER: Gender (Boy or Girl): _____ Date of Birth: _____ Surname: _____ First Names: _____ Identity Number: _____ Nationality: _____ Home Language: _____ Passport Number: _____ Name of Previous school : _____ Tel No of Previous school :_____ Address of Previous school : _____ Fax No of Previous school : _____ First Additional Language Choice (Grade 4 7 only): _____ (Afrikaans or Zulu) SIBLING Information : (cousins are not siblings) Name of Brother/Sister at Rosebank : _____ Grade: _____ Sports House: _____ ADDITIONAL Information : Deceased parent: Mother: _____ Father: _____ Both: _____ With whom does your child reside (parents, mother, father, grandparent, guardian)?

2 _____ Mode of Transport: _____ ( Taxi, Public, Private, Walk) Any Information that you feel the school should be made aware of? _____ _____ FOR OFFICE USE ONLY: Family Number: _____ Copy of s: _____ Admission Number: _____ Work in Area: _____ Sports House: _____ Live in Area: _____ LAF Paid: _____ Birth Certificate: _____ General Comments: _____ Immunisation Card: _____ _____ school Report: _____ _____ Proof of Income: _____ _____ GDE ONLINE NUMBER GR 1 _____ FATHER/GUARDIAN DETAILS: Surname: _____ First Names: _____ ID Number: _____ Title: _____ Nationality: _____ Marital Status: _____ Home Tel Number: _____ Cell Number: _____ Home Address: _____ Postal Address: _____ Employer: _____ Occupation: _____ Work Address: _____ Work Tel Number: _____ Work Fax Number: _____ E-Mail Address: _____ MOTHER/GUARDIAN DETAILS: Surname: _____ First Names: _____ ID Number: _____ Title: _____ Nationality.

3 _____ Marital Status: _____ Home Tel Number: _____ Cell Number: _____ Home Address: _____ Postal Address: _____ Employer: _____ Occupation: _____ Work Address: _____ Work Tel Number: _____ Work Fax Number: _____ E-Mail Address: _____ MEDICAL AID Information : Name of Medical Aid: _____ Medical Aid Number: _____ Main Member s Initials & Surname: _____ Allergies and/or Medical Problems: _____ In the event of hospitalisation, please indicate whether Private or Provincial Hospital: _____ DOCTOR S Information : Family Doctor s Name: _____ Telephone Number: _____ NEXT OF KIN / RELATIVE S DETAILS: (Other than Parent or Guardian) Surname: _____ First Names: _____ Relationship to Learner: _____ Telephone Number: _____ Address: _____ PAYMENT OF school FEES: Rosebank Primary school is a Sectional 21 school which is a fee paying school .

4 Consequently, parents / guardians are legally bound to pay school fees. Should a family renege on its responsibility to pay school fees, they can be blacklisted or have legal action taken against them by Rosebank Primary school . Please note that both parents are responsible for the payment of school fees. I understand and accept the school fee responsibilities: Name: _____ Signature: _____ Date: _____ Please note that if you are placed onto Waiting List A or B, there is no guarantee of acceptance of your application.