Physical Address: PIERNEEF AVE Witbank School Phone: 036562247 School Fax: 036902875 Admission Enquiry Child details THIS IS NOT AN ENROLMENT FORM IT IS ONLY AN ENQUIRY BY YOU FOR US TO CONSIDER ENROLLING YOUR CHILD IN 209 IF SPACE IS AVAILABLE AND IF YOU MEET THE SCHOOL S ADMISSION POLICY CRITERIA Learner Information: Grade Applying for: Highest Grade Passed: Year of Highest Grade Passed: For Grade Applicants only Name of Pre-School: Formal: Non-Formal: None: Surname: Initials: Preferred Date of Birth: YYYY: MM: DD: Gender: Male: Female: Country of Birth: Ethnic Group: Black White Coloured Indian Asian Country of Citizenship: Religion: Identity Number: Passport Number if no ID is provided: Physical Address: Monday - Friday Physical Address: Weekend Same as Previousl Address?: Distance From Home To School: 0-5 km 5-0 km 0-20 km 20 km + Mode of Transport to school: Car Bus Taxi Walking Child lives with Both Parents Mother Father Family Member Foster Parent Other If other state relationship: Alternative Phone: Home Language: Second Language: Preferred Language of Tuition: P age
Physical Address: PIERNEEF AVE Witbank School Phone: 036562247 School Fax: 036902875 Admission Enquiry Child details continued Learner Information: Parents Deceased: Both Father Mother Name of previous School: Has your child repeated a Grade? Yes No If Yes, which grade? Medical Aid Doctor: Medial Aid Number: Doctor s Telephone number: Medical Aid Main Member: Social Grant: Yes: No: Medical Condition: Allergies (if any): Disability: Yes No If Yes please specify: Number of children in family: Position of child in family: Only Youngest Middle Oldest Number of other Siblings at RCS at present: Specify details of other siblings at RCS at present: Grade: Position: Youngest Middle Oldest Grade: Position: Youngest Middle Oldest Grade: Position: Youngest Middle Oldest Specify details of your own children who have passed through RCS in the last 5 years Current Grade: Current Grade: After School Care: After School Centre Father Mother Domestic Worker Friend Family None Other If other please explain: 2 P age
Physical Address: PIERNEEF AVE Witbank School Phone: 036562247 School Fax: 036902875 Admission Enquiry Father/Legal Guardian Details Father or Legal Guardian Details: Surname: Initials: Title: Date of Birth: YYYY: MM: DD: Gender: Male Female Country of Birth: Ethnic Group: Black White Coloured Indian Asian Country of Citizenship: Religion: Identity Number: Home Language: Passport Number if no ID provided: Preferred Language: Stays km from RCS Yes No Works km from RCS Yes No Occupation: Work Address: Employer: : Gross Annual Salary: Email Address: Mobile Telephone: Work Telephone: Marital Status: Married Widower Divorced Step Father Relationship to child: Parent Grandparent Foster Parent Step Parent Legal Guardian Other: Please Specify: 3 P age
Physical Address: PIERNEEF AVE Witbank School Phone: 036562247 School Fax: 036902875 Admission Enquiry Mother/Legal Guardian Details Mother or Legal Guardian Details: Surname: Initials: Title: Date of Birth YYYY: MM: DD: Gender: Male Female Country of Birth: Ethnic Group: Black White Coloured Indian Asian Country of Citizenship: Religion: Identity Number: Home Language: Passport Number: Preferred Language: Stays km from RCS Yes No Works km from RCS Yes No Occupation: Work Address: Employer: : Gross Annual Salary: Email Address: Mobile Telephone: Work Telephone: Marital Status: Married Widow Divorced Step Mother Relationship to child: Parent Grandparent Foster Parent Step Parent Legal Guardian Other: Please Specify: 4 P age
Physical Address: PIERNEEF AVE Witbank School Phone: 036562247 School Fax: 036902875 Admission Enquiry Alternative Contact Details Contact Details of Close Relative or Friend: Name and Surname: Contact Number: Relationship: Mobile Telephone:. Work Phone: Email Address: Admission Enquiry Account Holder Details Account Holder Details/ Person responsible for payment of School Fees Account Holder: Father/ Legal Guardian: Mother/ Legal Guardian: Other/Company: Other: Please Specify: Payment Agreement: Over 0 Months: Over Months In Full Debit Order: Yes: No: EFT: Yes: No: Speed point/debit card Yes No Account Holder: Account Number: Bank Branch Code: 5 P age
Physical Address: PIERNEEF AVE Witbank School Phone: 036562247 School Fax: 036902875 Admission Enquiry Important Information Robert Carruthers is an English medium school catering for children whose mother tongue is English. All children who are accepted for enrolment for 209 may be required to attend an interview at the school to prove English proficiency. If your child is not proficient in English you are strongly advised to find a home language school for your child. Put a cross in the relevant block indicating your child s English proficiency with 5 being very proficient and not able to communicate in, or understand English. 5 4 3 2 Declaration: I, the Applicant, hereby declare that the information I have recorded on this form is true and correct. By my signature below, I give the Chairperson of the School Governing Body or his designate, permission to check and confirm any of the details contained herein. I understand that should any of the information supplied by me be found to be false, this Enrolment Enquiry will be deemed nul and void and my child will not be considered for placement at this school, now or at ANY OTHER TIME in the future Robert Carruthers School each year engages a private detective to check details provided on this enrolment enquiry. Signature of applicant (Father): Signature of applicant (Mother): SCHOOL MATTERS: Your signature at the bottom of this letter confirms that:. you are aware that Robert Carruthers School is an English Medium School, thus the language of Learning and Teaching at the school is English. Furthermore, you agree to have your child taught in English and that children already fluent in English will be given enrolment preference. 2. you acknowledge that Robert Carruthers School adheres to the National Curriculum and Assessment Policy (CAPS) which, at this stage, does not allow for the introduction of a 3 rd language. 3. you understand that loco parentis at Robert Carruthers School begins half an hour before the official school or school related function s starting time and ends half an hour after the official school or school function s ending time. 4. you will arrange to have your child collected within half an hour of any school-related activity as no staff member will be on duty after that time. 5. your child will be expected to participate in extra mural activities and that swimming forms part of the curriculum requirements; therefore Swimming and Physical Education are compulsory. No child will be excused from participating. 6. you acknowledge that Robert Carruthers is a Quintile 5 School and as such the payment of school fees is compulsory. 7. you understand that in accordance with SASA (Section 4) The governing body of a public school may by process of law enforce the payment of school fees by parents who are liable to pay 8. you acknowledge that it will be your responsibility to apply to the School Governing Body for any form of exemption from the payment of school fees if you are ever unable to pay your fees. 9. you agree to ensure that your child abides by the School Rules and Regulations. If your enquiry is successful, you will be given a copy of the Parent/Pupil Rules and Regulations and the School Code of Conduct. Your duty as a parent/legal guardian is to ensure that your actions, attitude and approach make it possible for your child to abide by these rules. Please note that the SASA Section 8(4) states Nothing contained in this Act exempts a learner from the obligation to comply with the code of conduct of the school attended by such a learner. Procedure: Enrolment enquiries MUST be returned by the Applicant before 3 July 208 at 4:00 and will be processed during the month of August. If you have not heard from us telephonically by 28 th September 208 your application has not been successful. Signed on this day of 20 at Signature of Applicant (Father) Signature of Applicant (Mother) 6 P age
Physical Address: PIERNEEF AVE Witbank School Phone: 036562247 School Fax: 036902875 For office use: Family code: House name: Signature Clerk: Grade: Date Accepted: Admission Number: Date: Tuition Agreement Signed: Yes No 7 P age