St. Henry’s Marist College

1 1 All signatories to initial: Version St. henry s Marist College APPLICATION FOR ADMISSION LEARNER'S surname : _____ LEARNER'S FIRST NAMES: _____ PROPOSED YEAR OF ENTRY: _____ PROPOSED GRADE OF ENTRY: Tick the appropriate box: PLEASE COMPLETE THE APPLICATION FORM BELOW AND RETURN IT TO ST henry 'S Marist College , PO BOX 30480, MAYVILLE, 4058 OR BY HAND TO 210 MAZISI KUNENE ROAD, DURBAN, 4001 TOGETHER WITH: 1. The application administration fee of R250 2. Certified copies of the Learner's two latest School Reports. 3. Certified copy of the Learner's Unabridged Birth Certificate. 4. Certified copy of the Learner's Baptism Certificate (Catholics only). 5. Health Certificate certifying that all statutory inoculations have been administered (Pre-Primary School applicants only) 6.

2 Certified copies of the Learner's Guardians ID books. 7. If the Parents are divorced, a certified copy of the court order confirming who the custodian parent/primary care giver is 8. If the Learner will not be residing with a Parent/Guardian during school term time, a certified copy of the carer s identity document, proof of address and a Power of Attorney signed by both Parent s and/or Guardian/s in favour of such person is required 9. In the case of Catholic applicants, a testimonial from the applicant's Parish Priest will enhance the applicant's chance of selection. 10. Financial Clearance Certificate from previous school (if applicable). 11. Certified copy of the Learner s study permit if the Learner is a foreign national.

3 If such a permit has not been granted at the time of application, then a certified copy must be provided as soon as it becomes available as the Learner will not be enrolled until such a permit has been provided to the College 12. Certified copy of a utility bill or bank account statement not older than 3 months with the Guardian s physical address thereon 13. The College reserves the right to conduct any credit bureau searches it deems necessary on any signatory hereto, and to satisfy itself that the Parent/Guardian/Third Party can afford the fees and extras charged by the College at time of submission of the Application. In order to confirm affordability and to facilitate the acceptance of this application, kindly attach copies of the last 3 months bank statements and or salary slips of the parties liable for the fees and any extras to this application.

4 PLEASE NOTE: (i) This form must be fully completed, signed in full at the places indicated, every page initialled and the required documents must be attached thereto. Incomplete applications will not be considered and any alteration/variation thereto, electronic or otherwise will be regarded a pro non scripto (unwritten). Gr000 4yr old Gr00 5yr old The Guardian/s and Third Party acknowledge having read the terms and conditions of this Application and confirm having understood these fully, and warrant that all the details set out herein are true and correct. They further confirm knowing that the terms and conditions include suretyships, indemnities, waivers and other duties and obligations imposed on them.

5 Signed: _____ Father/Guardian _____ Mother/Guardian _____ Third Party AFFIX PHOTOGRAPH OF LEARNER 2 All signatories to initial: Version (ii) If application is being made for more than one child, a separate application form is required for each child. (iii) Notification of Confirmation of Acceptance by the College will be in writing and subject to the payment of a non-refundable Admission Fee of R5000, which fee is payable within 15 days of the date of such written confirmation or before the commencement of the Learner s attendance at the College , whichever is the earliest, failing which it shall lapse and be of no further force or effect. A. LEARNER'S DETAILS LEARNER'S surname : _____ FIRST NAMES: _____ LEARNER'S PREFERRED NAME: _____ BOY GIRL (Mark selections with an x ) DATE OF BIRTH: _____ RELIGION: _____ If Catholic, has the Learner received the following Sacraments: BAPTISM RECONCILIATION EUCHARIST CONFIRMATION PARISH: _____ NAME OF PARISH PRIEST: _____ ARE THE APPLICANT'S PARENTS CATHOLIC?

6 FATHER: YES NO MOTHER: YES NO IS YOUR CHILD IN POSSESSION OF A HEALTH CERTIFICATE INDICATING THAT ALL STATUTORY INNOCULATIONS HAVE BEEN PERFORMED? (Pre-Primary school applicants only) YES NO LEARNER'S PRESENT SCHOOL: _____ ADDRESS OF THAT SCHOOL: _____ LEARNER'S PRESENT GRADE: _____ LEARNERS SCHOLASTIC ABILITY: _____ _____ LEARNER'S INTERESTS AND EXTRA-MURAL INVOLVEMENT (Sports, Clubs, Societies, etc.): _____ _____ _____ NUMBER OF CHILDREN IN FAMILY: _____ WHO WILL THE CHILD RESIDE WITH DURING SCHOOL TERM TIME: _____ ADDRESS OF CARER IF DIFFERENT FROM PARENTS ADDRESS: _____ _____ CONTACT TELEPHONE NUMBERS FOR THE CARER: HOME: _____ WORK: _____ CELLULAR: _____ IF PARENTS ARE DIVORCED OR SEPARATED, KINDLY ADVISE WHO THE CUSTODIAN PARENT/PRIMARY CARE GIVER: MOTHER FATHER ALL CORRESPONDENCE AND ACADEMIC RECORDS WILL BE ADDRESSED TO THE CUSTODIAN PARENT/PRIMARY CARE GIVER.

7 IS EITHER PARENT A PAST PUPIL OF THE College : YES NO OR A PAST PUPIL OF ANOTHER Marist College ? IF SO 3 All signatories to initial: Version WHICH College ? _____ WHAT YEARS? _____ AND SPORTS HOUSE? _____ DOES THE LEARNER HAVE BROTHERS OR SISTERS ASSOCIATED WITH THE College ? YES NO IF YES: NAME/S _____ YEAR _____ SPORTS HOUSE _____ NAME/S _____ YEAR _____ SPORTS HOUSE _____ NAME/S _____ YEAR _____ SPORTS HOUSE _____ NAME/S _____ YEAR _____ SPORTS HOUSE _____ What prompted you to apply for the Learner s admission to St henry 's Marist College ? Please tick the appropriate box and elaborate where applicable A Family connections with the College B Local Parish C Catholic affiliation D Press advertisements (please specify which publication) E Presentation at your child's present school F Sporting/cultural event G The College website H The College 's newsletters to your child's present school I Recommendation of the principal at your child's present school J Other (Please specify) B.

8 PARENT'S/GUARDIANS /THIRD PARTY'S DETAILS FATHER/GUARDIAN'S surname _____ TITLE: _____ FATHER/GUARDIAN'S FIRST NAMES: _____ FATHER/GUARDIAN'S PREFERRED FIRST NAME: _____ MARITAL STATUS: _____ IDENTITY NO.: _____ RESIDENTIAL ADDRESS: _____ _____ POSTAL CODE _____ POSTAL ADDRESS: _____ POSTAL CODE _____ TELEPHONE: HOME: _____ BUSINESS: _____ CELL: _____ EMAIL (PLEASE PRINT NEATLY) PROFESSION or OCCUPATION: _____ NAME AND PHYSICAL ADDRESS OF EMPLOYER: _____ _____ 4 All signatories to initial: Version IF SELF EMPLOYED, PLEASE FURNISH THE NAME, NATURE AND PHYSICAL ADDRESS OF YOUR BUSINESS: _____ _____ MOTHER/GUARDIAN'S surname _____ TITLE: _____ MOTHER/GUARDIAN'S FIRST NAMES: _____ MOTHER/GUARDIAN'S PREFERRED FIRST NAME: _____ MARITAL STATUS: _____ IDENTITY NO.

9 : _____ RESIDENTIAL ADDRESS: _____ _____ POSTAL CODE _____ POSTAL ADDRESS: _____ POSTAL CODE _____ TELEPHONE: HOME: _____ BUSINESS: _____ CELL: _____ EMAIL (PLEASE PRINT NEATLY) PROFESSION or OCCUPATION: _____ NAME AND PHYSICAL ADDRESS OF EMPLOYER: _____ _____ IF SELF EMPLOYED PLEASE FURNISH THE NAME, NATURE AND PHYSICAL ADDRESS OF YOUR BUSINESS: _____ _____ IF A THIRD PARTY IS RESPONSIBLE FOR THE FEES, PLEASE FILL IN THE FOLLOWING DETAILS: THIRD PARTY'S surname _____ TITLE: _____ THIRD PARTY'S FIRST NAMES: _____ MARITAL STATUS: _____ IDENTITY NO/REG NO.: _____ RESIDENTIAL ADDRESS: _____ _____ POSTAL CODE _____ POSTAL ADDRESS: _____ POSTAL CODE _____ TELEPHONE: HOME: _____ BUSINESS: _____ CELL: _____ EMAIL (PLEASE PRINT NEATLY) PROFESSION or OCCUPATION: _____ NAME AND PHYSICAL ADDRESS OF EMPLOYER: _____ _____ IF SELF EMPLOYED PLEASE FURNISH THE NAME, NATURE AND PHYSICAL ADDRESS OF THE THIRD PARTY S BUSINESS: 5 All signatories to initial: Version _____ _____ MEDICAL DETAILS AND EMERGENCY CONTACT MEDICAL INFORMATION: ANY ALLERGIES/MEDICAL CONDITIONS _____ ___ BLOOD TYPE: _____ DOCTOR S NAME: _____ CONTACT NO.

10 _____ ___ MEDICAL AID _____ MEDICAL AID NO. _____ DEPENDANT NUMBER AS SHOWN ON MEDICAL AID CARD: _____ PRINCIPAL MEMBER: _____ PRINCIPAL MEMBER S ID NO. _____ PRINCIPAL MEMBER S ADDRESS: _____ EMERGENCY CONTACT: NAME: RELATIONSHIP: ___ CONTACT NO. ___ C. DEPOSIT AND ELECTION OF METHOD OF PAYMENT OF SCHOOL FEES 1. Statements of account are to be sent to the following email address (PLEASE PRINT NEATLY) 2. As a period of payment I/we choose (please mark with a X) a. Full year in advance b. Four equal debit orders c. Ten equal monthly debit orders (January to October) 3. If the Guardian and/or Third Party elect to pay the school fees by debit order, then the applicable debit order authorization set out below is to be fully completed and signed, and the signatory acknowledges that the debit order will remain in force until cancelled in writing by the signatory, and that the College will automatically adjust the debit order each year to take into account any increases in fees.