APPLICATION FORM

I.R.LESOLANG HIGH SCHOOL





PRIVATE BAG X562
MABOPANE
0190
(012) 7040446
FAX: (012) 7070446
E-MAIL: irlesolang@telkom.sa.net




APPLICATION FOR ADMISSION TO I.R.LESOLANG HIGH SCHOOL

OFFICE USE ONLY (FIRST ADMISSION)


ACCEPT

WAITING LIST
DEPOSIT
PAID
ADMISSION
NUMBER ADMISSION
LETTER POSTED
(GREEN)


NB THE FORM MUST BE COMPLETED IN FULL BY THE PARENT/GUARDIAN/PROXY AND HANDED IN AT THE SCHOOL WHICH THE PUPIL ATTENDS AT PRESENT.

A. 1. THIS APPLICATION IS FOR THE SCHOOL YEAR 2008.

SURNAME AND FIRST NAME OF PUPIL:


B. PARTICULARS OF PARENT/GUARDIAN/PROXY

1. SURNAME:

2. FIRST NAMES (IN FULL):

3. SOUTH AFRICAN CITIZEN: * JA NEE IF NO, NAME COUNTRY OF ORIGIN



4. IDENTITY NUMBER:

5. PRESENT ADDRESS:
RESIDENTIAL:

POSTAL ADRESS:

WORK:

6. ALL CORRESPONDENCE SHOULD BE ADDRESSED TO * MY RESIDENTIAL /
WORK ADDRESS
7. TELEPHONE HOME WORK:

CELL FATHER: MOTHER:

E-MAIL ADDRESS:

8. OCCUPATION FATHER:
OCCUPATION MOTHER:
9. STATE WHETHER MARRIED, WIDOWED OR DIVORCED:


10. THE APPLICANT IS THE * PARENT/LEGAL GUARDIAN/PROXY:

11.
A IF THE APPLICANT IS NOT THE PARENT OR LEGAL GUARDIAN BUT THE PROXY,


B IS A WRITTEN STATEMENT ACCEPTING RESPONSIBILITY FOR THE ADVANCE PAYMENT? YES NO
NB: IF NOT, THE APPLICANT WILL BE HELD RESPONSIBLE FOR PAYMENT OF SCHOOL FEES UNTIL SUCH TIME AS THE WRITTEN STATEMENT HAS BEEN SUBMITTED).


D PARTICULARS OF PUPIL(S):

1 2 3
1 (A) SURNAME
(B) FIRST NAME
(C) MALE/FEMALE
(D) DATE OF BIRTH
(E) PRESENT GRADE
(F) PRESENT SCHOOL


2. IF A SEPARATE APPLICATION IS MADE TO PLACE BROTHERS/SISTERS OF THE ABOVE PUPIL INTO A DIFFERENT HOSTEL, PLEASE STATE THE NAME OF THE SCHOOL:


3. EXTRAMURAL ACTIVITIES:
I OBJECT/HAVE NO OBJECTION TO MY CHILD PARTICIPATING IN THE EXTRAMURAL ACTIVITIES OF THE SCHOOL:


4. MEDICAL TREATMENT:

A



B



C
WHICH CONTAGIOUS DISEASES HAS THE PUPIL HAD?


I UNDERSTAND THAT THE HOSTEL FEES DO NOT COVER THE COST OF MEDICAL TREATMENT. THE HOSTEL STAFF TAKE CARE OF HOME NURSING TO THE BEST OF THEIR ABILITY, MAKING USE OF THE MEDICINE WHICH IS AVAILABLE IN THE HOSTEL.

IN THE EVENT OF ILLNESS OR AN ACCIDENT WHERE, IN THE OPINION OF THE RESPONSIBLE OFFICER, MEDICAL TREATMENT WILL BE NECESSARY FOR MY CHILD AND WHERE I CANNOT BE NOTIFIED IN TIME, I WANT THE FOLLOWING DOCTOR TO BE CALLED:

(I) THE DISTRICT SURGEON, AS I AM DESTITUTE:

(II) MY FAMILY DOCTOR, NAMELY DR

(III) A LOCAL DOCTOR BECAUSE THE HOSTEL IS TO FAR FROM MY HOME DOCTOR TO VISIT HIM/HER


WHOSE ACCOUNT FOR TREATMENT AND PRESCRIBED MEDICINE MUST BE FORWARDED TO ME FOR PAYMENT.
D IN EXTREMELY URGENT CASES OF ILLNESS OR AN ACCIDENT WHERE I CANNOT BE CONSULTED IN TIME, I GIVE MY CONCERN THAT:

(I) THE SENIOR TAECHER/ DEPUTY MAY TAKE THE NECESSARY STEPS TO CALL THE BEST AVAILABLE DOCTOR, OR TAKE THE CHILD TO HOSPITAL AND, SHOULD A PRACTISING PHYSICIAN REGARD AN EMERGENCY OPERATION ESSENTIAL, HE/SHE MAY GIVE HIS/HER WRITTEN PERMISSION FOR IT ON MY BEHALF; AND
(II) I WILL BE RESPONSIBLE FOR THE COSTS.

5. THE CHILD’S STATE OF HEALTH, HANDICAPS OR AILMENTS:



6. SHOULD IT AT ANY TIME BE IMPOSSIBLE TO CONTACT ME DIRECTLY, YOU MAY CONTACT THE FOLLOWING FRIENDS/RELATIVES: (NAME AND TELEPHONE NUMBER PLEASE).



E. UNDERTAKING BY PARENT/GUARDIAN/PROXY:

1. SCHOOL REGULATIONS AND RULES:
I AM AWARE THAT MY CHILD’S ADMISSION IS SUBJECT TO THE RULES OF THE SCHOOL;

I AM PREPARED TO COMPLY WITH THE ABOVE AND UNDERTAKE TO:

A
B
C
PAY THE SCHOOL AND FEES REGULARLY AND IN ADVANCE, EVERY TERM;
GIVE A TERM’S NOTICE BEFORE I REMOVE MY CHILD FROM THE SCHOOL AND
COMPENSATE FOR ANY DAMAGE(S) TO SCHOOL PROPERY CAUSED BY MY CHILD, WHATEVER IT MAY BE.


DATE

SIGNATURE OF PARENT/GUARDIAN/PROXY

WITNESS: 1.
2.




* DELETE WHAT IS NOT APPLICABLE


WITNESS 1.

2.

DATE 1.

2.





I.R.LESOLANG HIGH SCHOOL (012) 7040446
A DETAILED CONFIDENTIAL REPORT BY THE PRESENT PRINCIPAL
1 2 3
NAME OF PUPIL
MALE / FEMALE
DATE OF BIRTH
PRESENT GRADE
PRESENT SCHOOL
CONTACT NUMBER OF SCHOOL
HOME LANGUAGE

1. SCHOLASTIC PROGRESS AT SCHOOL (LATEST EXAM MARKS)
AFRIKAANS
ENGLISH






2. AVERAGE
3. YEARS FAILED
4.
I.Q. (IF AVAILABLE) NV NV NV
V V V
T T T
5. BEHAVIOUR: HAS THIS PUPIL BEEN GUILTY OF SERIOUS OFFENCES (SMOKING, LIQUOR, FORBIDDEN SUBSTANCES) OR ANY BEHAVIOURAL PROBLEMS? IF SO, PLEASE DESCRIBE.
5.1
5.2
5.3
6. EXTRAMURAL ACTIVITIES:
6.1
SPORTS THE PUPIL
TAKES PART IN


6.2
ACHIEVEMENTS

7. OUTSTANDING SCHOOL FEES? REASON? YES NO





SIGNATURE: PRINCIPAL

DATEM



SCHOOL STAMP