Enrolment -


Enrolment Information
Day
Month
Year
The student's academic year level at entry
Student Details

First name
Middle name/s
Last name
 
Please enter your legal name as it appears on your Birth Certificate.
First name
Middle name/s
Last name
Day
Month
Year
Select gender
The student's previous school name
Residence A / Primary Contact Details*

Please enter the primary residence

Residence A - Caregiver 1

e.g. Mother's name
e.g. dsmith@gmail.com
e.g. 022 123 4567
e.g. 6 123 4567
e.g. 6 123 4567
Relationship to the student

Residence A - Caregiver 2

e.g. Father's name
e.g. bsmith@gmail.com
e.g. 022 123 4567
e.g. 6 123 4567
e.g. 6 123 4567
Relationship to the student
Please tick if the student resides at another address at times
Health Details

List any medical problems including hearing, allergies and diagnosed conditions
Special needs, disability or learning difficulties
Emergency Contact

Contact 1
e.g. 6 123 4567
e.g. 022 123 4567
e.g. Grandmother
Contact 2
e.g. 6 123 4567
e.g. 022 123 4567
e.g. Grandfather
Special Interests