Grade R Enrolment

Enrolment Form (grade R)

Date of Application

Year Starting at Benjamin

Learners Personal Details

First Name

Last Name

Date of Birth

Age

Gender

Home Language

2nd Language

Ethnic Group (Required by GDE)

Religion

Nationality

Who does the child live with?

Parents or Guardian Information:

Fathers Details:

First Name

Last Name

Mobile Number

Office Number

Home Number

ID Number

Religion

Residential Address

Postal Address

Employer

Occupation

Employer Address

Mothers Details:

First Name

Last Name

Phone/Mobile

Home Number

Office Number

ID Number

Religion

Residential Address

Postal Address

Employer

Occupation

Employer Address

Details of another contact in the case of an emergency:

First Name

Last Name

Relationship to Learner

Phone/Mobile

Home Number

Office Number

Medical Details:

Family Doctors Name

Contact number

Medical Aid Name

Membership Number

Main Members Initials & Surname

Main Members ID Number

Does the learner suffer from any allergies?

If YES, Please specify

In a critical medical situation, please bear in mind that there may NOT be time to refer to the learner records. The school, therefore, reserves the right to utilise the quickest medical services available.

By checking the box below, being the parent / legal guardian of the child you hereby agree that a medical practitioner may provide emergency treatment as may be necessary.

I agree.

Person Responsible For Payment of School Fees:

First Name

Last Name

Relationship to Learner

Phone/Mobile

Home number

Office Number

Please upload copies of the following documents for us to process your application. (Allowed files: pdf, png, jpg)

Clinic Card (Grade R & 1 Only)

Choose File

Birth Certificate

Choose File

Recent School Report

Choose File

Mothers ID

Choose File

Fathers ID

Choose File

Guardians ID

Choose File