Trailblazers Christian Academy
LEARNER INFORMATION:
Full Names
Surname
Preferred Name
Date of Birth
ID Number
Nationality
Religious Denomination
Gender —Please choose an option—MaleFemale
Ethnic Group
Home Language
Learner's Language Preference
Dexterity
Learner Mobile Number
Learner Email Address
Admission Date
Grade in 2021
Years in Grade for 2021
Years in Phase for 2021
Pre-primary Education Attended FormalInformalOther
Method of Transport
Taxi/Bus Registration Number
Name of Driver
Contact Number
FAMILY INFORMATION:
Family Status —Please choose an option—Both ParentsSingle Parent-UnmarriedSingle Parent-DivorcedFoster CareChildren's HomeRe-composedWidow/WidowerOther
Parents Deceased MotherFatherNone
LEARNER HEALTH INFORMATION:
Chronic Diseases
Allergies
Medication
MEDICAL AID INFORMATION:
Medical Aid Name
Telephone Number
Member Number
Primary Member Name
FAMILY DOCTOR INFORMATION:
Name
Street Address
City
Province
NEXT OF KIN INFORMATION
Alternative Contact Number
Relation
PREVIOUS SCHOOL/PLAY GROUP/ NURSERY INFORMATION
First Registration of Learner in North West? YesNo
Learner Attended School Last Year? —Please choose an option—YesNo
Province/Country?
Previous School
Highest Grade in Previous School
Reason for Leaving Previous School
BIOLOGICAL PARENT/LEGAL GUARDIAN 1 INFORMATION:
Title
Initials
Communication Preference SMSEmailMailBy Hand
Language Preference
Mobile Number
Home Number
Fax Number
Email Address
Postal Address
Occupation Status Own Employer ProfessionalOwn Employer Non ProfessionalHouse WifeContract WorkerStudentFull-timePart-timePensionerTemporaryUnemployed
Occupation
Employer
Work Telephone Number
Work Street Address
Is the Learner Living with this Parent? YesNo
BIOLOGICAL PARENT/LEGAL GUARDIAN 2 INFORMATION:
I the Parent/Guardian hereby declare that the information supplied in this form is true and just and that I, by way of accepting this form, authorise the Chairperson of the School Board of Directors or his/her representative to control and confirm any of the details supplied. I am aware that should any information supplied be found not to be true, I may be liable to a criminal offence.
ACCOUNTABLE PERSON'S INFORMATION: Biological Parent 1Biological Parent 2OtherCompany/Closed Corporation/Trust
INDIVIDUAL:
COMPANY/CLOSED CORPORATION/TRUST:
Registration Number
BANKING DETAILS: Bank
Branch
Branch Code
Account Type ChequeTransmissionSavings
Bank Account Number
Account Holder
CONTRACT/PERMISSIONS/INDEMNITY FORM DOWNLOAD
A downloadable Contract/Permissions/Indemnity form can be downloaded here:Download Form
Please sign, scan and upload in the "UPLOADS" section
UPLOADS:
Signed Contract/Permissions/Indemnity Form
Which Parent's ID Will You be Submitting? Single Parent/Guardian IDBoth Parent's IDs
Parent/Guardian 1 ID
Parent 2 ID
Learner Birth Certificate
Clinic Copy
Report Card
Learner Picture
