Fillable Little Earth Digital Application Form Eng Digital2 (Law for All South Africa)

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Little Earth Digital Application Form Eng Digital2 (Law for All South Africa)

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The Little Earth Digital Application Form Eng Digital2 (Law for All South Africa) form is 9 pages long and contains:

  • 8 signatures
  • 65 check-boxes
  • 180 other fields

Country of origin: SOUTH-AFRICA
File type: PDF

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1
Month and year applied for:
Surname:
Full names as on birth certificate:
Preferred name:
ID number: (fill in blocks)
Date of birth:
We require the following documents:
APPLICATION FOR ADMISSION
Wher e l ittle is gre at
SECTION 1: PERSONAL DETAILS OF CHILD
Copy of child’s birth certificate
Copy of child’s vaccination record
Copy of both parents ID documents
Section 1 – 10 completed and signed
Recent colour photo of your child
Please send the completed application to info@littleearth.co.za
and we will contact you immediately.
2
Age: (as on 1st day at Little Earth)
Name and relationship of person dropping child at school:
Name and relationship of person collecting child at school:
Gender:
Boy
O+ AB+ AB- B+ B- UNKNOWNA+ A-O-
Girl
Nationality:
Land of origin (if applicable):
Date of immigration (if applicable):
LANGUAGE(S) OF LEARNING AND TEACHING:
THE FAMILY:
CHILD’S MEDICAL DETAILS:
Home language:
Religion:
Residence of child: Parents Guardians Other
Blood type:
Family doctor:
Telephone number:
Doctor’s Address:
Name of Medical Fund:
Member number:
Main member’s initials and surname:
English class:
Afrikaans class:
Please note the following:
• The baby section (3 – 24 months) is bilingual, but communication will be in the preferred language.
• Little Earth’s older classes (2 – 5 years) might initially be bilingual depending on the numbers. Once there
is enough children for both languages, the classes will be divided between English and Afrikaans
Other spoken languages:
Number of children in family: Ranking order of child in family:
3
Has the child received all the necessary immunisations?
Does your child suffers from any illnesses or disabilities?
Does your child suffer from any allergies?
Did your child had any operations?
Has or does your child suffer from any psychological
or emotional conditions which needed
or still needs therapy or treatment?
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
If no, please state the reason:
MEDICAL CONSENT
In an emergency, the school will always contact the parents first. If the parents are not available, the school
reserves the right to utilise the quickest medical service available.
I, _________________________________ parent/guardian of __________________________________,
Signature of parent/guardian: ___________________________________________________________
Main member’s ID number (fill in blocks):
If yes, please supply details:
If yes, please supply details:
If yes, please supply details:
If yes, please supply details
Please specify any other relevant medical details:
agree that a medical practitioner may provide emergency treatment as necessary.
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4
SECTION 2: PERSONAL DETAILS OF FATHER/LEGAL GUARDIAN
Surname:
Full name as on ID document:
Preferred name:
Residential address:
Tel Home:
Occupation:
Postal address:
Tel Work:
Employer:
Work address:
Cell:
Email address: (please write legibly) :
Parental status:
Access rights to child
Titel:
ID number (fill in blocks):
Date of birth:
Marital status:
Mr Dr Prof Other
SECTION 3: PERSONAL DETAILS OF MOTHER/LEGAL GUARDIAN
Surname:
Preferred name:
Titel:
Date of birth:
Mrs Ms RevDr Prof Other
Child living
with parent/s
Access rights
in an emergency
Child’s legal guardian
Full name as on ID document:
Rev
5
Relationship:
Tel home:
Tel work:
Cell:
Email address: (please write legibly):
ID number (fill in blocks):
Name:
SECTION 4: DETAILS OF ANOTHER CONTACT
IN CASE OF AN EMERGENCY
Surname:
Residential address:
Tel Home:
Occupation:
Postal address:
Tel Work:
Employer:
Work address:
Cell:
Email address: (please write legibly) :
Marital status:
Parental status:
Access rights to child
Child living
with parent/s
Access rights
in an emergency
Child’s legal guardian
6
SECTION 5: DECLARATION OF PARENTS/LEGAL GUARDIANS
We, the undersigned,
Signature of father/legal guardian: Date:
Date:
(name of father/legal guardian)
(name of mother/legal guardian)
SECTION 6: DETAILS OF THE PERSON RESPONSIBLE
FOR PAYING THE ACCOUNT (ACCOUNT HOLDER)
Surname:
Full name as on ID document:
Titel:
MrsMr Ms RevDr Prof Other
ID number (fill in blocks):
Relationship:
Residential address::
Tel home:
Occupation:
Postal address:
Tel work:
Employer:
Work address:
Marital status: :
Hereby certify that the information given by us in this application for admission is complete and accurate.
We also agree to the conditions as set out herein.
We accept that the school is based on Christian principles and undertake that this will not be undermined.
We understand that the prescribed number of children per class may be exceeded.
Signature of mother/legal guardian:
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7
Cell:
Email address: (please write legibly:
Monthly EFT:
Annually in advance:
Ouerstatus:
NB: THE SIG
NATURES OF BOTH PARENTS AND/OR LEGAL GUARDIANS ARE REQUIRED WHERE APPLICABLE
Other
SECTION 7: FINAN CIAL TERMS AN D CON DITIONS
PAYMENT OPTIONS:
DECLARATION OF ACCOUNT HOLDER
We, the undersigned,
(name of father/legal guardian)
(name of mother/legal guardian)
Signature of account holder: Date:
Date:
Access rights to child
Child living
with parent/s
Access rights
in an emergency
Child’s legal guardian
1. Fees for 12 (twelve) months are payable monthly in advance on or before the 3rd day of each calendar month
or annually in advance by 31st of December.
2.
Little Earth reserves the right to charge 15% interest on all accounts that are in arrears by 30 days or longer.
3. In the event where the undersigned surety, account holder or legal guardian commits a breach of contract,
the school may in its sole discretion refuse the child to attend school.
4. Fee increases will take place in January. Parents will be informed in writing one month in advance.
5. The enrolment fee is a once-off and non-refundable fee.
6. In the event where the account holder fails to pay the school fees and Little Earth takes legal action against
the account holder, he/she will be liable for paying all legal fees.
Hereby certify that the information given by the account holder in this application for admission is complete and accurate.
We accept joint liability to Little Earth for the due and punctual payment of the once-off, non-refundable enrolment fee,
school fees and any other amounts which may become due and payable to the school or in respect of participation in or
attendance of any extra-curricular activities.
Signature of 2nd parent/legal guardian:
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8
SECTION 8: GENERAL INDEMNITY
SECTION 9: PERMISSION TO USE PHOTOS
Herewith I,
Herewith, I give permission for above
I do not give permission for above
(name of Father/legal guardian)
(signature of Father/legal guardian)
(name of Mother/legal guardian)
(signature of Mother/legal guardian)
Signed at:
on
(location)
(date)
Father/legal guardian:
Witness 1:
Mother/legal guardian:
Witness 2:
Little Earth undertakes to implement measurements to ensure the safety and well being of the child, educators and
visitors to the school at all time and to conduct and manage the various school activities in a responsible manner.
Accidents happens from time to time and Little Earth cannot accept any responsibility for accidents that may take
place in the class or on the school grounds, except if such loss, damage or injury arises as a consequence of the
gross negligence or wilful misconduct of the school.
Little Earth seeks a very high standard of hygiene and health. To prevent the spreading of any infectious diseases,
sick children are not allowed to attend school.
indemnify Little Earth of any losses or damage in general whilst participating in school activity, except if such loss,
damage or injury arises as a consequence of the gross negligence or wilful misconduct of the school.
From time to time, informal photos are taken at school from the children. These photos may be used in electronic or
print media which has been approved by Little Earth. All photos will be treated anonymous.
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9
SECTION 10: CANCELLATION OF APPLICATION
-
Signature of Account Holder Date:
FOR OFFICE USE
Appointment date:
Commencement date:
Siblings at Little Earth:
Credit reference:
Notes:
Class/group:
Family code: Approved:
The account holder undertakes to give 30 (thirty) calendar days written notice of termination of the enrolment of the
child referred to in this document. In failing to do so, the liability incurred for the full amount of the following calendar’s
month school fees.
The full fees will be charged for the month of December, as December will not be accepted or acknowledged as a month of notice.
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Little Earth Digital Application Form Eng Digital2 (Law for All South Africa)

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Completed 5 December 2020

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