- Benjamin Preparatory School -

Telephone: +27 11 868 1404 | Mobile: +27 60 991 0962 | Email: info@benjaminprep.co.za

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We strive to give our learners the best education possible, in a friendly and caring atmosphere.

GRADE R
06h45 - 14h00
GRADE 1 - 4
07h45 - 14h00
GRADE 5
CLASS STARTS: 2022

Online Application

Online Application

Please ensure that your full physical address, postal address, contact numbers are stated correctly on your application form.

Date Of Application*

Date Starting*

Grade RGrade 1Grade 2Grade 3Aftercare

Learner's Personal Details:

First Name*

Surname*

Date Of Birth*

Age*

Gender*

FemaleMale

Home Language*

Other Language*

Race (Required by GDE)*

Religion*

Nationality: (Please specify if not South African)*

Who does the child live with? *

Both ParentsMotherFatherOther

Parents or Guardian Information:

Father’s Details:

First Name*

Surname*

Mobile Number*

Home Number

Office Number

Email Address

ID Number

Religion*

Residential Address*

Postal Address*

Employer*

Occupation*

Office Number

Employer Address*

Mother’s Details:

First Name*

Surname*

Mobile Number*

Home Number

Office Number

Email Address

ID Number

Religion*

Residential Address*

Postal Address*

Employer*

Occupation*

Office Number

Employer Address*

Details Of Another Contact In The Case Of An Emergency:

First Name*

Surname*

Relationship To Learner*

Mobile Number*

Home Number

Office Number

Medical Details:

Family Doctor's Name

Contact Number

Medical Aid Details:

Insurer's Name

Membership Number

Main Member's Initials and Surname

Main Member's ID Number

Does the learner suffer from any allergies?*

YesNo

If YES, please specify:

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

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

Person Responsible For Payment Of School Fees:

First Name*

Surname*

Relationship To Learner*

Mobile Number*

Home Number

Office Number

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

CLINIC CARD (Grade R and 1 only)

BIRTH CERTIFICATE

RECENT SCHOOL REPORT

MOTHER'S ID

FATHER'S ID

GUARDIAN’S ID

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