Have you completed the following forms and do they form part of your application? (Simply state YES or NO)

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1 RHS: APPLICATION FORMS: 1. Admission to RHS 2. Subject choice form 3. Admission to a school hostel PLEASE NOTE Forms 1 and 2 are compulsory Forms 3 and 4 are optional and are to be completed only if applicable to the individual case. This page is the front cover of the complete application Name of learner: Grade (2018): Date of application: Have you completed the following forms and do they form part of your application? (Simply state YES or NO) 1. Admission to RHS 2. Subject choice form 3. Admission to a school hostel NB: Because of the size of classes and/or roster limitations it might happen that the amount of English Home Language candidates might be restricted to 35. In such a case the school has the right to use performance and/or learner s home language as selection criteria.

2 APPLICATION TO BE ACCEPTED INTO AN ORDINARY PUBLIC SCHOOL NAME OF SCHOOL: ROBERTSON HIGH SCHOOL ADMISSION NO... A: DETAILS OF LEARNER Form 1 SURNAME: KNOWN AS:... FIRST NAMES:.... RESIDENTIAL ADDRESS:... SEX: HOME LANGUAGE:. DATE OF BIRTH:... ID NO:. NAME OF LAST SCHOOL ENROLLED IN:. REASON FOR LEAVING:. HIGHEST GRADE PASSED:... ORIGINAL BIRTH CERTIFICATE AVAILABLE:.... DATE OF LATEST ORIGINAL SCHOOL REPORT: NUMBER OF CHILDREN IN FAMILY: POSITION OF THIS LEARNER IN FAMILY:1 ST, 2 ND, 3 RD.. FAITH:... BIBLE STUDIES: DO YOU, AS PARENT OR GUARDIAN OF THIS LEARNER, HAVE ANY OBJECTIONS IN PRINCIPLE TO HIM/HER BEING PRESENT WHEN BIBLE STUDY, AS PRESCRIBED IN THE EDUCATION ACT, IS TAUGHT? YES / NO:.. GRADE(S) FAILED PREVIOUSLY (GRADE AND YEAR):.. DATE ON WHICH SCHOOL PRESENTLY/PREVIOUSLY ATTENDED WILL BE/WAS LEFT LEADERSHIP POSITIONS PREVIOUSLY HELD BY LEARNER OUTSTANDING ACHIEVEMENTS IN SPORT AND CULTURAL ACTIVITIES:.... SPORTING ACTIVITIES WHICH LEARNER PLANS TO TAKE UP AT RHS (UNDERLINE THOSE THAT APPLY): RUGBY, NETBALL, HOCKEY, TENNIS, BI-ATHLON, SWIMMING, ATHLETICS, CRICKET. CULTURAL ACTIVITIES WHICH LEARNER PLANS TO TAKE UP AT RHS (UNDERLINE THOSE THAT APPLY): CHOIR, DEBATING, PUBLIC SPEAKING, ACSS, CHESS EXTRA-MURAL ACTIVITIES: I HEREWITH GRANT PERMISSION THAT THIS LEARNER MAY TAKE PART IN EXTRA-MURAL AND SPORT ACTIVITIES AT RHS:. UNDERLINE ILLNESS(ES) WHICH THIS LEARNER HAS ALREADY HAD: MEASELS, GERMAN MEASELS, WHOOPING COUGH, CHICKEN POX, MUMPS. DOES THE LEARNER SUFFER FROM ANY CHRONIC ILLNESS(ES) OR ALLERGIES? IF SO, PLEASE SPECIFY: DOES THE LEARNER RECEIVE ANY TREATMENT FOR THE ABOVE-MENTIONED ILLNESS(ES) OR ALLERGIES?. IF SO, PLEASE SPECIFY:... HAS THE LEARNER HAD ANY OPERATION(S)?. IF SO, PLEASE SPECIFY DATE AND NATURE OF SUCH OPERATION(S)....

3 2. ILLNESS(ES) AGAINST WHICH THE LEARNER HAS BEEN INNOCULATED: TUBERCULOSIS(BCG) POLIOMYELITIS.. DIPTHERIA, TETANUS (DT) WHOOPING COUGH (DPT) HAEMOPHILUS INFLUENZAE TYPE B (HIB) TO BE COMPLETED BY THE LEARNER: I,..(Full names of learner), hereby declare that: 1. I am currently a learner in Grade. at.. (name of school attended). 2. I passed my highest grade in a fair and honest manner. 3. the report indicating that I passed the previous grade, reflects the correct state of affairs. Received and signed on this day of (Signature of leaner) B DETAILS OF PARENT(S) OR GUARDIAN(S) (Information requested should be furnished in respect of every parent or guardian.) FATHER FULL NAMES AND SURNAME: OCCUPATION: ID NUMBER (IF SA CITIZEN): PASSPORT NO: (IF FOREIGNER):.... RESIDENTIAL ADDRESS:.. POSTAL ADDRESS:. POSTAL CODE TELEPHONE NO (HOME): (CELL):..... TELEPHONE NO (OFFICE):.( ADDRESS):.... NAME AND ADDRESS OF EMPLOYER:.. POSTAL CODE MEDICAL AID FUND: NAME.. MEMBERSHIP NO:. MOTHER FULL NAMES AND SURNAME: OCCUPATION: ID NUMBER (IF SA CITIZEN): PASSPORT NO: (IF FOREIGNER):.... RESIDENTIAL ADDRESS:.. POSTAL ADDRESS:. POSTAL CODE TELEPHONE NO (HOME): (CELL) :... TELEPHONE NO (OFFICE):.( ADDRESS):.... NAME AND ADDRESS OF EMPLOYER:.. POSTAL CODE MEDICAL AID FUND: NAME.. MEMBERSHIP NO:. 3.

4 GUARDIAN ANAN FULL NAMES AND SURNAME: NATURE OF GUARDIANSHIP (E.G. FOSTER PARENT, UNCLE, GRANDMOTHER ETC.):.. (in case of legal guardianship or foster care, documentary evidence needs to be submitted) OCCUPATION: ID NUMBER (IF SA CITIZEN): PASSPORT NO: (IF FOREIGNER):.... RESIDENTIAL ADDRESS:.. POSTAL ADDRESS:. POSTAL CODE TELEPHONE NO (HOME):.. (CELL) :.... TELEPHONE NO (OFFICE): ( ADDRESS):.... NAME AND ADDRESS OF EMPLOYER:.. POSTAL CODE MEDICAL AID FUND: NAME. MEMBERSHIP NO:.... FULL NAME:. NUMBER TO BE DIALLED IN CASE OF EMERGENCY: DECLARATION BY PARENT /GUARDIAN I., the parent/guardian of (name of learner) declare that: 1. The information stated above is correct ; 2. I am the legal father/mother/guardian of the above-mentioned learner; 3. I accept the code of conduct of Roberston High School and will adhere to it. SIGNED AT. ON THIS DAY OF.(MONTH).. (YEAR) SIGNATURE OF PARENT / GUARDIAN PRINT NAME

5 C. PAYMENT OF SCHOOL FUNDS 4. To complete 1 and 2 hereunder by drawing a cross (X) in the applicable space. Payment will be made: 1. monthly (10 instalments ) per cheque in cash 2. quarterly ( 4 instalments) 3. once-off before/or on 25 February DETAILS OF OTHER LEARNERS AT SCHOOL WHO ARE ALSO DEPENDENT ON THE PERSON TAKING RESPONSIBILITY FOR THE LEARNER MENTIONED IN A ABOVE FIRST NAMES AND SURNAME GRADE I,, the undersigned, being the parent/guardian of... (name and surname of learner) herewith declare that the information furnished above is correct. I further commit myself to all undertakings given in section C above and accept liability for funds due at any time in terms of the agreement as set out above. I confirm that the address mentioned herein is my chosen domicilium citandi executandi address for purposes of service of all process should I not comply with any of my undertakings in terms of this agreement unless I have notified the school in writing of the change of my address in which case the new address will serve as my domicilium address. SIGNED AT. on this.. day of....(month). (year) SIGNATURE OF PARENT / GUARDIAN PRINT NAME D. DECISION REGARDING ADMISSION OF LEARNER (TO BE COMPLETED BY PRINCIPAL OF RHS I herewith declare that (name of learner) complies with the minimum age requirements for admission to a public school and that his/her latest end-of-year report was found to be true. His/her admission to grade.. has been approved. Comments:.. Signature of principal Date.. OR I herewith declare that (name of learner) was refused admission to grade..for the following reason(s): (Delete that which is not applicable.) He/she does not comply with the minimum age requirements for admission to a public school. He/she has not passed grade.. Other reason(s). Comments:.. Signature of principal Date..

6 RHS : SUBJECT CHOICE Form 2 Name of learner:.. Gr. (2018): GRADE 8-9 Complete the following: ENGLISH Home Language (First Language) ENGLISH Additional Language (Second Language) YES: NO: YES: NO: GRADE Complete the following: SUBJECT: YOUR CHOICE: COMPULSORY SUBJECTS: 1. Afrikaans Home Language Afrikaans Home Lang. 2. English Home Language OR First Additional Language 3. Life Orientation Life Orientation 4. Mathematics OR Mathematical Literacy CHOICE SUBJECTS: 5. Physical Science OR History OR Computer Application Technology (CAT) 6. Life Science OR Business Study OR Tourism 7. Accountancy OR Geography OR Consumer Study OR Engineer Graphics and Design EXTRA SUBJECTS: (Optional) 8. Computer Applications Technology Private music lessons can be taken at school. Contact the school for more information... SIGNATURE OF PARENT: DATE:

7 PROVINCIAL ADMINISTRATION OF THE WESTERN CAPE DEPARTMENT OF EDUCATION Form 3 APPLICATION FOR ADMISSION OF A LEARNER TO A SCHOOL HOSTEL The completed form should be kept in a safe place for as long as the learner stays in the hostel, and thereafter for as long as the parent/guardian owes hostel fees. In cases where debts have been passed on to the Provincial Accountant for collection, this form as well as other correspondence applicable to the case, should accompany the application. The forms should be kept in a single folder in numerical order, based on admission numbers. 1. Name of hostel. 2. Full name of learner Date of birth. 3. Name of school currently attended 4. Current grade 5. Date on which admission is required Details of parent/guardian 6.1 Full name Residential address Postal address Occupation 6.5 ID No 6.6 Telephone No. HOME..OFFICE 6.7 Name and address of employer. 6.8 Medical Aid Name Address Membership No Has the learner been admitted to the school associated with this hostel? School nearest to home of parent/guardian: Name of school Distance to school from home 9. Hostel nearest to home of parent/guardian: 10. Should the hostel listed at no. 1 not be the one nearest to the home of parent/guardian, state why the learner is not accommodated in that hostel Reasons for leaving the school attended at present 12. Does the learner suffer from any health problems or physical defects?... If so, please specify 13. Operations and dates thereof Underline the illness(es) that the learner has had: Measels, German Measles, Whooping Cough, Chicken Pox, Mumps. Scarlet Fever, Diphtheria, Rheumatic Fever State any other illness(es) not stated above, which the learner has had:......

8 15. Underline the Illness(es) against which the learner has been inoculated: Poliomyelitis, -2- Diphtheria, Whooping Cough, Tetanus, Tuberculosis(ECG), Measles, German Measles, Mumps. 16. Name of doctor to be called in case of illness..tel. 17. Religious denomination Declaration and undertaking by parent/guardian: 18.1 I, the undersigned parent/guardian of the above-mentioned learner, hereby declare that the information as furnished is correct, and I undertake to Accept liability for the full hostel fee for one school term, should this application be successful and my child not take up the accommodation, unless the committee exercising general control over the hostel decides otherwise; Accept liability for the full hostel fee for one school term, should this application be successful, and should my child then take up accommodation on a date later than that which is stated in par.5 above, unless the said committee decides otherwise; Give written notice of the intention to cancel the accommodation, this notice to be given at least one school term in advance, except in a case where the said committee accepted a shorter notice and, should I not comply with this arrangement, to accept liability for the full hostel fee of such child until the end of the school term in respect of which such notice should have been given Pay the hostel fees, as determined by the Department from time to time, in advance at the beginning of each term Comply with the internal rules and regulations of the hostel; 18.2 The superintendent acts as in loco parentis for all learners accommodated in the hostel and, as such, is authorised to act on my behalf in all cases of emergency, medical and other. DATE. SIGNATURE OF PARENT /GUARDIAN N.B. 1. In terms of the rules and regulations of hostels, learners whose hostel fees have not been paid by the end of the term, for that specific term, may be excluded from the hostel in the following term, and they may not be allowed to take up such accommodation until overdue hostel fees have been paid. 2. The Department accepts no liability for any loss of, or damage to, personal possessions of learners accommodated in the hostel, irrespective of the cause of such loss or damage. 3. Parents are strongly advised to have the possessions of their children insured against fire, theft, etc.

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