RONDEBOSCH EAST PRIMARY SCHOOL 4TH AVENUE RONDEBOSCH EAST 7780 TEL: 021 - 6971403 FAX: 08602123771

E-mail: head.reps@gmail.com Website: www.rondeboscheastps.com

APPLICATION FOR ADMISSION GRADE _ R_ 2021

ADDITIONAL DOCUMENT (All information supplied must be correct. Should there be any discrepancies, this application will become null and void.

Any false information supplied is a criminal offence.) FOR OFFICE USE:

PLEASE NOTE THE FOLLOWING:

THIS APPLICATION MUST BE ACCOMPANIED BY THE FOLLOWING BEFORE A LEARNER MAY BE ADMITTED TO A Western Cape EDUCATION DEPARTMENT SCHOOL:

(a) CERTIFIED COPY OF UNABRIDGED BIRTH CERTIFICATE OF LEARNER

(b) CERTIFIED COPIES OF BOTH PARENTS’ ID DOCUMENTS

(c) ONE RECENT ID SIZE PHOTOGRAPH OF THE LEARNER (only on final acceptance)

(d) CERTIFIED COPY OF IMMUNISATION (CLINIC) CARD – ALL CHILDREN MUST BE IMMUNISED

(e) PROOF OF RESIDENTIAL ADDRESS OF THE CHILD, I.E. RATES ACCOUNT OR UTILITY BILL (Please note:

Clothing Store, Cellular Bill or other similar Account statements, as well as affidavits WILL NOT be accepted as proof of

address.) Should none of the above documents be available, a BANK STATEMENT will be required

(f) A COPY OF THE LATEST SCHOOL REPORT (WHERE APPLICABLE)

ADDITIONAL INFORMATION:

(a) After notification of acceptance an INITIAL FEE of R1000 towards the School Technology Fund must be paid to confirm acceptance

of the place offered or it will be forfeited

(b) AN INCOMPLETE APPLICATION FORM WILL NOT BE ACCEPTED

(c) YOU MUST APPLY TO A MINIMUM OF 5 SCHOOLS AS PER WESTERN CAPE EDUCATION DEPARTMENT INSTRUCTION - AS AN APPLICATION DOES NOT GUARANTEE ACCEPTANCE.

SECTION A: LEARNER INFORMATION (PRINT CLEARLY) Surname of Learner

(as stated on the Birth Certificate) First Names

Boy Girl Home Language Nationality

Date of Birth: ID Number

Physical Address

Religion:

Telephone Number:

Position in Family Only or first child Second child Third child Fourth child or more

PARENT INFORMATION

PROOF OF ADDRESS

ID: BOTH PARENTS (Certified)

DEPOSIT PAID

EXEMPTION APPLICATION

OTHER SUPPORTING DOCS

NECESSARY VISAS (Foreigners)

SPONSOR ID

LEARNER INFORMATION

BIRTH CERTIFICATE CLINIC CARD PREV. REPORT

CEMIS CERTIFICATE STUDY PERMIT

ADMINISTRATION

DATE ISSUED DATE RETURNED GRADE/ CLASS CEMIS NUMBER ACCEPTED WAITING LIST NOT ACCEPTED

Are there any other children (brothers or sisters NOT cousins) at Rondebosch East Primary? If yes, please state names and grade.

Name Grade

Name Grade

Child lives with (please tick)

Both Parents Mother Father Legal Guardian

SECTION B: SCHOLASTIC INFORMATION Please list names of the schools the learner/student has attended and their CEMIS number.

A Transfer form from the previous school MUST be handed in at the office on entry to Rondebosch East Primary School

Name of School Country/ Province

Contact Number

Reason for Leaving

LEARNER CEMIS

NUMBER Pre-Primary/Grade R It is very important for you to name the school your child is at

if you are applying for Grade 1 NOT APPLICABLE

Foundation Phase Grade 1 – 3

InterSen Phase Grade 4 – 7

Please supply the LEARNER CEMIS NUMBER. It may be obtained from their current school.

SECTION C: MEDICAL INFORMATION VERY IMPORTANT FOR OUR DATA BASE PLEASE COMPLETE

Condition Medication

Allergies/ Medical/Chronic Illnesses (peanuts, bee stings, etc.)(Diabetes, epilepsy etc.)

Disabilities: (hearing impaired, partially sighted, autistic spectrum disorder, ADHD, etc.) Please provide CERTIFIED proof

May your child participate in extra-mural activities:

Yes / No (Please Circle). If No, state reasons and supply medical evidence:

…………………………………………………………………………………………………………………………………..

Underline illness(es) learner has been immunised against: Tuberculosis (B.C.G.) / Diptheria / Whooping cough / Tetanus / Measles / German Measles / Mumps / Poliomyelitis. (PLEASE NOTE: LEARNERS SHOULD HAVE BEEN IMMUNISED AGAINST ALL THE ABOVE ILLNESSES BEFORE SCHOOL ATTENDANCE. IMMUNISATION AGAINST POLIOMYELITIS AND TUBERCULOSIS (B.C.G.) IS LEGALLY COMPULSORY. AN IMMUNISATION CERTIFICATE OR COPY OF A CLINIC CARD WILL BE REQUIRED PRIOR TO SCHOOL ATTENDANCE. )

Medical Aid Name and Number

Doctor’s Name and Number

SECTION D: LEARNING/ SOCIAL/ PSYCHOLOGICAL SUPPORT INFORMATION

Has your child been encountering learning problems? Yes / No (Please circle)

If Yes: Please explain briefly:

Has your child been assessed by a Clinical psychologist? Yes / No (Please circle)

Name: _______________________ Tel: _______________ Address: ________________________________________________

Has your child required remedial or Occupational Therapy before? Yes / No (Please circle)

If Yes: Please supply details: (Use a separate sheet if necessary)

PARENTS’ DETAILS – PLEASE PRINT CLEARLY E.g. father, mother, step-parent, adoptive parent, grandparent, guardian, etc. Every child has two parents – a

biological mother and a father. According to SA Law both parents are responsible for school fee accounts and details of both parents MUST be completed. If a parent is deceased please ensure that the school has a copy of the death certificate. Please note a person who acts in the capacity of a parent is also deemed as a parent of the child.

PARENT

1111

PARENT 2

Parental Role: e.g.: (Mother / Father/ Guardian)

Surname and Title : e.g. (Mr, Mrs, Dr, Prof, etc.)

First Name:

ID Number: A certified copy of both ID

documents must accompany this form

Physical Address: Certified copy of

proof of residency (rates, telephone account

etc.) must accompany this form.

Postal Address: Please include postal code.

Home Telephone:

Cell Number: (NB)

Occupation:

Employer/Company Name:

Work Address:

Work Telephone:

E-mail Address: (NB)

PRINT CLEARLY

Emergency contact other than parents and not living at the same address

Name and Relationship (Grandparent, aunt, friend, etc.)

Contact Numbers: Cell: Work/Home

SECTION E: PARENT INFORMATION - COMPULSORY (Incomplete information indicates an incomplete application)

MARITAL STATUS (PLEASE TICK)

Married

Common Law Marriage

Separated

Divorced

Divorce & Remarried

Unmarried

Deceased

Father Mother

SECTION F:

SMS Contact Service Information (SMS WEB) - must be either one parent/guardian. Please supply us with the cell number for contact by sms.

(only 1 per family permitted) Mother/ Father /Guardian

NB!!! A fee of R30 is payable should you require a second

number to be added to the sms database.

SECTION H: Data regarding to the payment of school fees (COMPULSORY)

Please note that Rondebosch East Primary is a declared FEE-PAYING SCHOOL in terms of the relevant legislation, and that by enrolling your child at the school, you are accepting an obligation to contribute financially towards the

education he/ she receives.

I understand that Rondebosch

East Primary is a fee paying

school, and am willing and

able to meet my obligations in

this regard in full.

Yes Comment:

I intend paying the full

school fees applicable.

Yes

No

Name, address and contact

numbers of person/s

responsible for payment of

school fees.

Name:

Identity Number:

Cellular Number:

Home Address: Work Address:

Code:

Code:

Home Tel: Work Tel:

Personal E-mail: Work E-mail:

Relationship to Learner: Tick the relevant box:

LEGAL PARENT GUARDIAN GRANDPARENT STEP PARENT OTHER - Indicate below

_____________________

SECTION G: PAYMENT WILL BE MADE: (Please tick)

Annual (minus 10% discount if settled before 31 January) OR (minus 5% discount if settled before 28 February )

Quarterly (February/April/July/October)

Monthly (cheque/EFT over 10 months: January - October)

Debit Order (10 months: February – November) MOST PREFERRED IF MONTHLY PAYMENT OPTION IS CHOSEN

SECTION I: Declaration/undertakings by applicant/parents/guardian

1. We have read and understood the statements and questions on this form. The information supplied by us, individually or

together, is complete and true in every respect. If any of the supplied information is found to be incomplete, incorrect, untrue or misleading, the School may cancel any offer of a place and refuse to accept any future application in respect of the same applicant.

2 We undertake to accept and abide by the Code of Conduct of the School, and such rules and regulations as are put in place by the School or Governing Body from time to time. We accept further that the applicant will be under the disciplinary control of the school from the date on which he/ she commences his/her studies at the school, to the date on which he/she is withdrawn from or leaves the school. I/We understand and confirm that the Principal or any person duly authorized, will act in loco parentis in any matter and at any time during which I /we have entrusted our child to the care of the school.

3. We accept that tuition is offered in English (language of teaching). 4. We accept that the school and its employees may: 4.1 at its sole discretion, report to the parents or guardian any breaches of discipline by the applicant as it deems necessary/advisable. 4.2 report to the same people on any matter concerning the progress, conduct, well-being or health of the applicant. 4.3 take such steps as it deems reasonable, in the event of the enrolled pupil becoming ill, being injured, or for any reason requiring medical attention where the parents cannot be contacted. 5. I/We jointly and severally undertake to pay school fees and we/I understand the following :

5.1 The current school fees is a compulsory sum of Gr R: R11650; Gr 1 – 7: R9000.00 per annum. The school fees for 2021 will be decided at a Budget Meeting in November and is, per regulation, adopted by the majority of parents at said Meeting. 5.2 The full school fee is payable on 1 January 2021 but parents are allowed to enter into a payment plan. 5.3 The fee may be paid off in 10 monthly instalments by debit order or via another option offered. Fees are due and payable at the beginning of each month with effect from 1 February to 1 November. 5.4 In terms of Section 39 of the South African Schools Act, the parties to this form are liable to pay compulsory school Fees. 5.5 In terms of Section 40 of the South African Schools Act, the school may enforce the payment of these compulsory fees. 5.6 Should we fail to meet the legal responsibility for such school fees as are payable in terms of the law, and fall into arrears in terms of school fee payments, we accept that we will be jointly and severally liable for the arrears PLUS collection commission interest charged and all costs of recovery, including fees charged by attorneys on the scale as between attorney and client. 5.7 Parents who are unable to pay school fees may apply for exemption from these fees – this only applies to learners from Grade 1 to 7 (not Grade R) 5.8 Grade R only: I understand that my child may be de-registered should school fees fall into arrears.

6. I/We undertake to give one month’s notice in writing of any intention to remove my/our child from the school and furthermore, to return any books and/or equipment belonging to the school which our child may have. 7. I/We understand that the school reserves the right to verify all information supplied to them via this application. In the event of fraudulent documents submitted, the school reserves the right to lay a criminal charge of fraud against any of the parties to this application. 8. We accept liability for any damage to the school or school property caused by the applicant, howsoever it may occur. 9. We indemnify the School against any claim whatsoever which may arise as a result of the applicant’s attendance at school or any school activity, acknowledging that the applicant’s participation in any sporting or other activity at or through the school, and including the use of transport arranged by the school, may entail risks, and that such participation or use shall be at the sole and absolute risk of the applicant and his parent or guardian.

10. I/We undertake to notify the school in writing of any changes to our personal particulars or contact details. 11. I/We accept the responsibility of the pupil’s transport to and from the school. 12. I/We acknowledge that the Staff Road gate is not opened for children before 07:00 am and also undertake to collect my child within 30 minutes of the close of school each day or make arrangements for aftercare facilities. 13. I/We undertake to inform the principal of our child’s / children’s absence from school. Parents / guardians declare that they are prepared to produce a doctor’s certificate if and when required; 14. I/We undertake to support the school’s constitution and policy of admission, as defined and implemented by the Governing Body of the school. 15. This commitment in its entirety will be valid from the day on which it is signed by the parent / guardian to the day on which the pupil officially leaves the school. The Governing Body reserves the right to reconsider the admittance of pupils to the school. The parent / guardian declares that he / she is the legal guardian of the child and is entitled to sign this document, and shall be bound hereto both as parent / guardian, and in his / her personal capacity.

Signature of father:

Date:

Signature of mother:

Date:

Signature of legal guardian/s: (Attach proof of guardianship)

Date:

SECTION J: MEDIA CONSENT MEDIA CONSENT FORM AND RELEASE FOR MINOR CHILDREN

I hereby GRANT / DO NOT GRANT (please circle) Rondebosch East Primary School and their agents the absolute right and permission to use photographic portraits, pictures, digital images or videotapes of my child, or in which my child may be included in whole or part, or reproductions thereof in colour or otherwise for any lawful purpose whatsoever, including but not limited to use in any school publication or on the school website or media accounts, without payment or any other consideration. I hereby waive any right that I may have to inspect and/or approve the finished product or the copy that may be used in connection therewith, wherein my child’s likeness appears, or the use to which it may be applied. I hereby release, discharge, and agree to indemnify and hold harmless the school, Rondebosch East Primary School and their agents from all claims, demands, and causes of action that I or my child have or may have by reason of this authorization or use of my child’s photographic portraits, pictures, digital images or art work, including any liability by virtue of any blurring, distortion, alteration, optical illusion, or use in composite form, whether intentional or otherwise, that may occur or be produced in the taking of said images or art work, or in processing tending towards the completion of the finished product, including publication on the internet, in brochures, or any other advertisements or promotional materials.

Signed: ………………………………………. Date: …………………………….

NOTE: BOTH BIOLOGICAL PARENTS MUST SIGN THE FORM, UNLESS AN AFFIDAVIT OR PROOF OF LEGAL GUARDIANSHIP IS SUBMITTED

(All information supplied must be correct. Should there be any discrepancies, this application

will become null and void. Any false information supplied is a criminal offence.)

SECTION K: Checklist

(NB: All signatures are essential. If the form has not been signed, it will not be processed.)

1 Have pages 1, 2, 3, 4 and 5 of this form been completed?

2 Have both parents or guardian/s signed the form?

3 Has the applicant’s most recent school report been included? (Learners in Grades 1-7)

4 If the applicant is a South African citizen, is a copy of his unabridged birth certificate included?

5 If the applicant is not an SA citizen, has a copy of his study permit been included?

6 Have you entered the details of the persons’ responsible for school fees?

7 Have you signed and understood the declaration and undertakings in SECTION I?

8 Have you included all required attachments and copies as indicated on the application information form?