Application Form Thank you for showing interest in Country House School. Please fill out our Enrolment form and we will get back to you as soon as possible. Child First Name Child Last Name Gender Male Female Child Date of Birth Upload a profile picture of your child Which education package suits you? Half day (13:30pm, no later than 14:00pm) Full day (17:00pm, no later than 17:30pm) Which Class / Grade are you Applying for? Under 1 year of age 1 year turning 2 years 2 years turning 3 years 3 years turning 4 years 4 years turning 5 years Grade R Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6 Grade 7 Grade 8 Grade 9 Residential address Street Name & Number Suburb Province Zip Code Upload proof of residential address Desired start date List any allergies List any medical conditions Your medical aid service provider Your preferred hospital in case of emergency Your child's medical aid number Anything else we should know about your child? Do you require Additional Pick Up for Aftercare? Yes No Upload information for additional pick up (If applicable) Your First Name Your Last Name Your Email Your Phone Your Relationship to the child? Father Mother Grandparent Legal Guardian Your ID or passport number Upload a copy of your ID or passport Additional Parent First Name Additional Parent Last Name Additional Parent Email Additional Parent Phone Additional Parent Relationship to the child? Father Mother Grandparent Legal Guardian Additional Parent ID or passport number Upload Additional Parent copy of your ID or passport Upload a copy of your child's birth certificate/ID Upload a copy of your child's immunisation record Consent I hereby certify that the information provided in this Application for Admission is complete and accurate. Where did you hear about us? Facebook Google Search Google Maps Flyer BillBoard Word of mouth Walk in / saw the building Emails Why did you choose us? Location Friendliness of staff Facilities Cleanliness Opening hours Reputation Price Recommendation Outdoor Staff qualifications Activities Security Curriculum Staff child/ratio Send
